MEDICARE: DR. BRENDAN HUBBARD DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	36794	TX

General Provider Information

NPI Number	:	1629646138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDAN HUBBARD DDS, MS

Provider Business Mailing Address
First Line	:	713 VICTORIAN DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-5246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4880 N PRESIDENT GEORGE BUSH HWY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-2742
Country	:	US
Telephone Number	:	385-985-9184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2021
Last Update Date	:	06/12/2021

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