Provider Demographics
NPI:1578117438
Name:HUBRED, CHRISTINA MARIE (A DT, DH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:HUBRED
Suffix:
Gender:F
Credentials:A DT, DH
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DH
Mailing Address - Street 1:MISKOVICH DENTAL CLINIC
Mailing Address - Street 2:1121 SE 4TH AVENUE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-326-3437
Mailing Address - Fax:218-327-1211
Practice Address - Street 1:MISKOVICH DENTAL CLINIC
Practice Address - Street 2:1121 SE 4TH AVENUE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744
Practice Address - Country:US
Practice Address - Phone:218-326-3437
Practice Address - Fax:218-327-1211
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT75125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist