Provider Demographics
NPI:1033524483
Name:KUBEK, DANIEL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:KUBEK
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S 4TH ST
Mailing Address - Street 2:SUITE 950C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2593
Mailing Address - Country:US
Mailing Address - Phone:502-587-6131
Mailing Address - Fax:502-584-8600
Practice Address - Street 1:455 S 4TH ST
Practice Address - Street 2:SUITE 950C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2593
Practice Address - Country:US
Practice Address - Phone:502-587-6131
Practice Address - Fax:502-584-8600
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist