Provider Demographics
NPI:1578730297
Name:HUBBELL, WILLIAM RUSSELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:HUBBELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:R
Other - Last Name:HUBBELL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:1980 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1520
Mailing Address - Country:US
Mailing Address - Phone:810-987-9666
Mailing Address - Fax:810-987-6363
Practice Address - Street 1:1980 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1520
Practice Address - Country:US
Practice Address - Phone:810-987-9666
Practice Address - Fax:810-987-6363
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011497122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics