Provider Demographics
NPI:1891801239
Name:HUBBARD, GARY TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:TODD
Last Name:HUBBARD
Suffix:
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 1:33 TALSMAN DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1207
Mailing Address - Country:US
Mailing Address - Phone:330-533-5975
Mailing Address - Fax:
Practice Address - Street 1:33 TALSMAN DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1207
Practice Address - Country:US
Practice Address - Phone:330-533-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist