Provider Demographics
NPI:1376627828
Name:JAKUBAITIS, STEVEN (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JAKUBAITIS
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 1:2866 TAMIAMI TRAIL
Mailing Address - Street 2:SUITE F
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5126
Mailing Address - Country:US
Mailing Address - Phone:941-629-4400
Mailing Address - Fax:941-764-0000
Practice Address - Street 1:2866 TAMIAMI TRAIL
Practice Address - Street 2:SUITE F
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5126
Practice Address - Country:US
Practice Address - Phone:941-629-4400
Practice Address - Fax:941-764-0000
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist