Provider Demographics
NPI:1043297781
Name:KUBA, MARK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:KUBA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1724 NEBRASKA AVE
Mailing Address - Street 2:BLDG 1608
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8939
Mailing Address - Country:US
Mailing Address - Phone:573-396-0408
Mailing Address - Fax:573-596-0314
Practice Address - Street 1:1724 NEBRASKA AVE
Practice Address - Street 2:BLDG 1608
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8939
Practice Address - Country:US
Practice Address - Phone:573-396-0408
Practice Address - Fax:573-596-0314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO142251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice