1194278499 NPI number — HUBBARD PARK FAMILY DENTISTRY, PLLC

Table of content: (NPI 1194278499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194278499 NPI number — HUBBARD PARK FAMILY DENTISTRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUBBARD PARK FAMILY DENTISTRY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194278499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
174 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTPELIER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05602-2262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-229-9494
Provider Business Mailing Address Fax Number:
802-229-4515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTPELIER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-229-9494
Provider Business Practice Location Address Fax Number:
802-229-4515
Provider Enumeration Date:
08/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
MARISA
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
802-229-9494

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  016000292 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007197 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com