Provider Demographics
NPI:1386368371
Name:BRYANNA HUBBARD DENTAL CORPORATION
Entity type:Organization
Organization Name:BRYANNA HUBBARD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-943-5517
Mailing Address - Street 1:9105 BALLARD DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5772
Mailing Address - Country:US
Mailing Address - Phone:818-943-5517
Mailing Address - Fax:
Practice Address - Street 1:916 W BURBANK BLVD STE A
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1448
Practice Address - Country:US
Practice Address - Phone:818-943-5517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty