Healthcare Provider Details

I. General information

NPI: 1265359228
Provider Name (Legal Business Name): ADELINE HUBBARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E 5TH ST
CARUTHERSVILLE MO
63830-1417
US

IV. Provider business mailing address

6738 STATE HIGHWAY 77
BENTON MO
63736-8238
US

V. Phone/Fax

Practice location:
  • Phone: 573-922-5007
  • Fax: 573-922-5117
Mailing address:
  • Phone: 573-313-2500
  • Fax: 573-293-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026027345
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: