Provider Demographics
NPI:1720534555
Name:HUBBARD, JABRENTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JABRENTA
Middle Name:
Last Name:HUBBARD
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 1:8715 HIGHWAY 265
Mailing Address - Street 2:
Mailing Address - City:MOUNT CROGHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29727-9789
Mailing Address - Country:US
Mailing Address - Phone:702-349-5550
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:NAVY HOSPITAL CAMP PENDLETON
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-719-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8769 GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice