Provider Demographics
NPI:1356725204
Name:HUBBARD, SUE-LYNN (DDS)
Entity type:Individual
Prefix:
First Name:SUE-LYNN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MENTEITH CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2633
Mailing Address - Country:US
Mailing Address - Phone:240-353-9926
Mailing Address - Fax:
Practice Address - Street 1:616 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4625
Practice Address - Country:US
Practice Address - Phone:410-747-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist