Provider Demographics
NPI:1164449088
Name:BARTON A. KUBELKA, D.D.S., INC.
Entity Type:Organization
Organization Name:BARTON A. KUBELKA, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUBELKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-594-8769
Mailing Address - Street 1:10951 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2378
Mailing Address - Country:US
Mailing Address - Phone:562-594-8769
Mailing Address - Fax:562-594-5631
Practice Address - Street 1:10951 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2378
Practice Address - Country:US
Practice Address - Phone:562-594-8769
Practice Address - Fax:562-594-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty