Provider Demographics
NPI:1417033150
Name:KUBIK, GREGORY FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:FRANK
Last Name:KUBIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 COVENTRY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7548
Mailing Address - Country:US
Mailing Address - Phone:815-455-7757
Mailing Address - Fax:
Practice Address - Street 1:490 COVENTRY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7548
Practice Address - Country:US
Practice Address - Phone:815-455-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics