Provider Demographics
NPI:1801909445
Name:HUBBARD, LARRY G (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
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:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-0718
Mailing Address - Country:US
Mailing Address - Phone:912-654-3046
Mailing Address - Fax:912-654-3047
Practice Address - Street 1:1007 E BARNARD ST
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-2603
Practice Address - Country:US
Practice Address - Phone:912-654-3046
Practice Address - Fax:912-654-3047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9053122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist