Healthcare Provider Details

I. General information

NPI: 1710801816
Provider Name (Legal Business Name): HUB CITY ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 HARDY ST STE 20
HATTIESBURG MS
39401-7056
US

IV. Provider business mailing address

3102 HARDY ST STE 20
HATTIESBURG MS
39401-7056
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-5027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN DOUGLAS
Title or Position: OWNER
Credential: DMD
Phone: 954-600-5027