Provider Demographics
NPI:1558769794
Name:JUBIDENTAL SERVICES CORP
Entity Type:Organization
Organization Name:JUBIDENTAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANEPSI
Authorized Official - Middle Name:
Authorized Official - Last Name:COTELO-PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-444-3074
Mailing Address - Street 1:299 ALHAMBRA CIR
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5106
Mailing Address - Country:US
Mailing Address - Phone:305-444-3074
Mailing Address - Fax:844-270-7764
Practice Address - Street 1:299 ALHAMBRA CIR
Practice Address - Street 2:SUITE # 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5106
Practice Address - Country:US
Practice Address - Phone:305-444-3074
Practice Address - Fax:844-270-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty