Provider Demographics
NPI:1689728651
Name:CUBERO DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:CUBERO DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-822-0663
Mailing Address - Street 1:5920 CUBERO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3867
Mailing Address - Country:US
Mailing Address - Phone:505-822-0663
Mailing Address - Fax:505-797-0531
Practice Address - Street 1:5920 CUBERO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3867
Practice Address - Country:US
Practice Address - Phone:505-822-0663
Practice Address - Fax:505-797-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20311223G0001X
NM14801223G0001X
NM22981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty