Provider Demographics
NPI:1912159633
Name:GUGALA, HUBERT L (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:L
Last Name:GUGALA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2939
Mailing Address - Country:US
Mailing Address - Phone:908-241-2114
Mailing Address - Fax:908-241-6001
Practice Address - Street 1:2305 WOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2939
Practice Address - Country:US
Practice Address - Phone:908-241-2114
Practice Address - Fax:908-241-6001
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP570301223S0112X
NJ22DI024058051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472281913Medicaid