Provider Demographics
NPI:1982883690
Name:ANN HUBBS FAMILY DENTISTRY INC
Entity type:Organization
Organization Name:ANN HUBBS FAMILY DENTISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-636-8700
Mailing Address - Street 1:4001 W FINANCIAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-5804
Mailing Address - Country:US
Mailing Address - Phone:479-636-8700
Mailing Address - Fax:479-372-4055
Practice Address - Street 1:4001 W FINANCIAL PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1449
Practice Address - Country:US
Practice Address - Phone:474-636-8700
Practice Address - Fax:479-372-4055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANN HUBBS FAMILY DENTISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162724608Medicaid