Healthcare Provider Details

I. General information

NPI: 1306008792
Provider Name (Legal Business Name): DR WILLIAM R HUBBELL JR DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 HOLLAND AVE
PORT HURON MI
48060-1520
US

IV. Provider business mailing address

1980 HOLLAND AVE
PORT HURON MI
48060-1520
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9666
  • Fax: 810-987-6363
Mailing address:
  • Phone: 810-987-9666
  • Fax: 810-987-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901011497
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901011497
License Number StateMI

VIII. Authorized Official

Name: DR. WILLIAM RUSSELL HUBBELL JR.
Title or Position: CEO
Credential: DDS
Phone: 810-987-9666