Provider Demographics
NPI:1013374164
Name:TUBIS, DMITRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:TUBIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 W CAMERON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2720
Mailing Address - Country:US
Mailing Address - Phone:626-962-4428
Mailing Address - Fax:626-962-9789
Practice Address - Street 1:1710 W CAMERON AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2720
Practice Address - Country:US
Practice Address - Phone:626-962-4428
Practice Address - Fax:626-962-9789
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist