=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396356499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT R HUBBARD DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2020
-----------------------------------------------------
Last Update Date | 08/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W BOWER AVE
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72601-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-741-1050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 W BOWER AVE
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72601-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-741-1050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT HUBBARD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 870-741-1050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------