Provider Demographics
NPI:1851443188
Name:HUBBARD, DONN BROOKS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONN
Middle Name:BROOKS
Last Name:HUBBARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 E. 13 MILE RD.
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-771-9414
Mailing Address - Fax:586-772-3468
Practice Address - Street 1:16216 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1524
Practice Address - Country:US
Practice Address - Phone:586-771-9414
Practice Address - Fax:586-772-3468
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist