Provider Demographics
NPI:1962684142
Name:HUBBI, SAMAR (DMD)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:HUBBI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1709
Mailing Address - Street 2:110 BERGEN STREET
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN STREET
Practice Address - Street 2:RECEPTION AREA #4
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101-0328
Practice Address - Country:US
Practice Address - Phone:973-972-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023605001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics