Provider Demographics
NPI:1598796518
Name:HUBBARD COSBY, VENNIS D (DMD)
Entity Type:Individual
Prefix:
First Name:VENNIS
Middle Name:D
Last Name:HUBBARD COSBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 MIDLAND WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-7203
Mailing Address - Country:US
Mailing Address - Phone:706-221-7534
Mailing Address - Fax:
Practice Address - Street 1:6501 VETERANS PKWY
Practice Address - Street 2:SUITE 1-A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3169
Practice Address - Country:US
Practice Address - Phone:706-221-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADE0140441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics