Provider Demographics
NPI:1851502884
Name:HUB CITY ORTHODONTICS, P.A.
Entity Type:Organization
Organization Name:HUB CITY ORTHODONTICS, P.A.
Other - Org Name:WILSON ORTHODONTICS, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-733-5230
Mailing Address - Street 1:1118 KLICK WAY
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3469
Mailing Address - Country:US
Mailing Address - Phone:301-733-5230
Mailing Address - Fax:301-733-5367
Practice Address - Street 1:1118 KLICK WAY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3469
Practice Address - Country:US
Practice Address - Phone:301-733-5230
Practice Address - Fax:301-733-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115431223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty