Larry G Hubbard, D.D.S.
Individual provider Active NPI General Practice Dentistry · Glennville, GA
NPI 1801909445 · NPPES record last updated Dec 19, 2023
Key facts
- NPI
- 1801909445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9053 (GA)
- Practice address
- 1007 E Barnard St
Glennville, GA 30427-2603 - Phone
- (912) 654-3046
- Fax
- (912) 654-3047
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150710002605 | GA | Order and Referring Only - Dentist |
7214249747 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9053 | GA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9053 | GA | |
| General Practice Dentistry | 1223G0001X | 9053 | GA | Yes |
Addresses
Primary practice location
1007 E Barnard St
Glennville, GA 30427-2603
Mailing address
PO Box 718
Glennville, GA 30427-0718
Phone (912) 654-3046
Other providers in Glennville, GA
- Glenvue H&R Nursing LLC
- Glenvue Operations LLC
- Michelle Ledesma Glisson
- Victoria Kangeter Griffith
- Joseph C Hand III
- Jessica Joyner Huggins
- Kenneth Brant Kicklighter Jr.
- Hee-Jun Gregory Kim
- Brennan Elizabeth King
- Lee Joshua Martin
All providers in Glennville, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.