Healthcare Provider Details

I. General information

NPI: 1275547556
Provider Name (Legal Business Name): H TODD CUBBON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 S KINGS RD
CRETE IL
60417-9631
US

IV. Provider business mailing address

24949 S WOODLAND DR
CRETE IL
60417-3447
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-6612
  • Fax: 780-672-6619
Mailing address:
  • Phone: 708-672-6012
  • Fax: 780-672-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: