Active NPI
James Clinton Hubred, DDS
- Dentist
- Moose Lake, MN
National Provider Identifier
1124055330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8463
- Practice address
- 304 Elm Ave.
Moose Lake, MN 55767 - Phone
- (218) 485-4455
- NPI assigned
- Jun 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8463 | MN | Primary |
Addresses
Primary practice location
304 Elm Ave.
Moose Lake, MN 55767
Mailing address
4105 County Road 8
PO Box 775
Moose Lake, MN 55767-8135
Phone (218) 485-8402
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8463 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Downtown Dental Care PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Moose Lake, MN
- NPI 1073674529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124055330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4105 COUNTY ROAD 8",
"address_2": "PO BOX 775",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "557678135",
"telephone_number": "218-485-8402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 ELM AVE.",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "55767",
"telephone_number": "218-485-4455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBRED",
"first_name": "JAMES",
"middle_name": "CLINTON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D8463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moose Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.