Provider Demographics
NPI:1346760824
Name:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH LLC
Entity Type:Organization
Organization Name:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH LLC
Other - Org Name:SOUTHERN OAKS FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-927-8663
Mailing Address - Street 1:8564 JEFFERSON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3557 MONTERREY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-2918
Practice Address - Country:US
Practice Address - Phone:225-927-8663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-26
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty