Provider Demographics
NPI:1982821591
Name:RONALD D. HUBBARD,DDS,PA
Entity Type:Organization
Organization Name:RONALD D. HUBBARD,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-448-3191
Mailing Address - Street 1:201 WEST MAIN ST.
Mailing Address - Street 2:POST OFFICE BOX 1717
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1717
Mailing Address - Country:US
Mailing Address - Phone:870-448-3191
Mailing Address - Fax:870-448-3199
Practice Address - Street 1:201 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-1717
Practice Address - Country:US
Practice Address - Phone:870-448-3191
Practice Address - Fax:870-448-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty