MEDICARE: DR. DELORES HUBBARD D.D.S

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	1223G0001X	General Practice Dentistry	DN009437	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942381801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELORES HUBBARD D.D.S

Provider Business Mailing Address
First Line	:	1784 WASHINGTON AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-4148
Country	:	US
Telephone Number	:	404-766-8559
Fax Number	:	404-766-7742

Provider Business Practice Location Address
First Line	:	1784 WASHINGTON AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-4148
Country	:	US
Telephone Number	:	404-766-8559
Fax Number	:	404-766-7742

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/10/2012

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