Provider Demographics
NPI:1164516902
Name:KUBA, REENA (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:KUBA
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 N HERITAGE PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-892-1200
Mailing Address - Fax:903-813-1581
Practice Address - Street 1:2921 N HERITAGE PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-1200
Practice Address - Fax:903-813-1581
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1798803-01Medicaid