Provider Demographics
NPI:1740385970
Name:KUBIAK, WILLIAM DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:KUBIAK
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 1:324 W SUPERIOR ST
Mailing Address - Street 2:SUITE 828
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1719
Mailing Address - Country:US
Mailing Address - Phone:218-722-3679
Mailing Address - Fax:
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:SUITE 828
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1719
Practice Address - Country:US
Practice Address - Phone:218-722-3679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist