Provider Demographics
NPI:1528124773
Name:HUBBELL, DAVID ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 MAIN ST STE 114
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2836
Mailing Address - Country:US
Mailing Address - Phone:972-624-0068
Mailing Address - Fax:972-624-8066
Practice Address - Street 1:3805 MAIN ST
Practice Address - Street 2:SUITE 114
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2836
Practice Address - Country:US
Practice Address - Phone:972-624-0068
Practice Address - Fax:972-624-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263854722OtherEIN