Provider Demographics
NPI:1619179702
Name:KUBIKIAN, DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KUBIKIAN
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 1:340 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1856
Mailing Address - Country:US
Mailing Address - Phone:856-256-7778
Mailing Address - Fax:856-256-7702
Practice Address - Street 1:340 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2322
Practice Address - Country:US
Practice Address - Phone:856-256-7778
Practice Address - Fax:856-256-7702
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0352571223P0300X
NJ22D022706011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics