Provider Demographics
NPI:1891966123
Name:HUBARD, EDUARDO E (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:E
Last Name:HUBARD
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 1:1404 M D LANE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5349
Mailing Address - Country:US
Mailing Address - Phone:850-656-8461
Mailing Address - Fax:850-656-8432
Practice Address - Street 1:1404 M D LANE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5349
Practice Address - Country:US
Practice Address - Phone:850-656-8461
Practice Address - Fax:850-656-8432
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN109661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics