Carly Gubin

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40045 Issued in TX

Practice address

904 W University Ave Ste 101
Georgetown, TX 78626-6512

Phone

(615) 329-4790

NPI assigned

Feb 28, 2022

Last updated

Sep 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1275289209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 W 6TH ST UNIT B",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787034704",
            "telephone_number": "901-233-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 W UNIVERSITY AVE STE 101",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786266512",
            "telephone_number": "615-329-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUBIN",
        "first_name": "CARLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-28",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11919",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40045",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Taylor Grimsley, PA-C
• Griselda Pattillo, LCSW PLLC
• Emily Wilburn Grooms, M.A., CCC-SLP
• Guadalupe County Hospital Board (The Wesleyan at Scenic)
• Guadalupe County Hospital Board (Park Place Care Center)
• Austin Michael Guidry
• Supraja R. Gulla, MD
• Jeffrey Gunter, FDN-P, CFMHC
• Nadia Gutierrez
• Victoria Evette Guyton, N.P.

• General Practice Dentistry in Georgetown, TX
• Providers in Georgetown, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.