Provider Demographics
NPI:1689742249
Name:HUBLY, JACQUELINE LEE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEE
Last Name:HUBLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:LEE
Other - Last Name:HUBLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4704 CHOKEBERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-904-3198
Mailing Address - Fax:
Practice Address - Street 1:6800 MAIN STREET
Practice Address - Street 2:SUITE 315
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist