Provider Demographics
NPI:1689684953
Name:WILLIAM F KUBICEK III DDS INC
Entity Type:Organization
Organization Name:WILLIAM F KUBICEK III DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:KUBICEK
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-831-8118
Mailing Address - Street 1:3690 ORANGE PLACE
Mailing Address - Street 2:465
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-8118
Mailing Address - Fax:216-831-8653
Practice Address - Street 1:3690 ORANGE PLACE
Practice Address - Street 2:465
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-8118
Practice Address - Fax:216-831-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300141091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty