Provider Demographics
NPI:1295806768
Name:HUBBARD, RONALD DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAVID
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 1:201 WEST MAIN STREET
Mailing Address - Street 2:POB 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
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139391631Medicaid
AR105533608Medicaid