Provider Demographics
NPI:1578532446
Name:KUBOVICH, MATTHEW PERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PERRY
Last Name:KUBOVICH
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 1:4949 WESTOWN PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6702
Mailing Address - Country:US
Mailing Address - Phone:515-225-0066
Mailing Address - Fax:515-226-0998
Practice Address - Street 1:4949 WESTOWN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6702
Practice Address - Country:US
Practice Address - Phone:515-225-0066
Practice Address - Fax:515-226-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1745344OtherCONCORDIA
IA35184OtherBC/BS
IA8110OtherDELTA DENTAL
IA1291575Medicaid