Provider Demographics
NPI:1164630430
Name:BUBENIK, JAMES E (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BUBENIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3736
Mailing Address - Country:US
Mailing Address - Phone:314-725-7080
Mailing Address - Fax:314-725-0832
Practice Address - Street 1:8112 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3736
Practice Address - Country:US
Practice Address - Phone:314-725-7080
Practice Address - Fax:314-725-0832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist