Provider Demographics
NPI:1699833731
Name:CUBOL, JANET BERNARDINO (DMD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:BERNARDINO
Last Name:CUBOL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5601
Mailing Address - Country:US
Mailing Address - Phone:707-469-6211
Mailing Address - Fax:707-469-7024
Practice Address - Street 1:961 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5601
Practice Address - Country:US
Practice Address - Phone:707-469-6211
Practice Address - Fax:707-469-7024
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice