Basic Information
| Provider Information | |||||||||
| NPI: | 1336498104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN G. HUBBARD, DDS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 568 | ||||||||
| Address2: | 63 CARR STREET | ||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250430568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045874232 | ||||||||
| FaxNumber: | 3045872092 | ||||||||
| Practice Location | |||||||||
| Address1: | 63 CARR ST | ||||||||
| Address2: | |||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250439402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045874232 | ||||||||
| FaxNumber: | 3045872092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2012 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | HUBBARD | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | GABRIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3045874232 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.