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General NPI Number Information
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NPI Number | 1306008792
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Entity Type | Organization
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Legal Business Name | DR WILLIAM R HUBBELL JR DDS PC
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1980 HOLLAND AVE
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City | PORT HURON
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State | MI
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Zip | 48060-1520
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Country | US
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Telephone | 810-987-9666
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Fax | 810-987-6363
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Provider Business Mailing Address
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Address Line | 1980 HOLLAND AVE
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City | PORT HURON
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State | MI
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Zip | 48060-1520
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Country | US
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Telephone | 810-987-9666
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Fax | 810-987-6363
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM RUSSELL HUBBELL JR.
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Credential | DDS
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Telephone | 810-987-9666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901011497
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901011497
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License Number State | MI
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