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General NPI Number Information
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NPI Number | 1578730297
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL HUBBELL JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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