Provider Demographics
NPI:1174814115
Name:KUBINSKI, DANA MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:KUBINSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6110
Mailing Address - Country:US
Mailing Address - Phone:734-778-5106
Mailing Address - Fax:
Practice Address - Street 1:43401 N JEFFERSON AVE BLDG 825
Practice Address - Street 2:
Practice Address - City:SELFRIDGE ANGB
Practice Address - State:MI
Practice Address - Zip Code:48045-5266
Practice Address - Country:US
Practice Address - Phone:586-239-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014312124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist