Provider Demographics
NPI:1871655159
Name:DUBUQUE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:DUBUQUE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:N
Authorized Official - Last Name:KILBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-556-4234
Mailing Address - Street 1:1890 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002
Mailing Address - Country:US
Mailing Address - Phone:563-556-4234
Mailing Address - Fax:563-556-0597
Practice Address - Street 1:1890 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002
Practice Address - Country:US
Practice Address - Phone:563-556-4234
Practice Address - Fax:563-556-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082171223G0001X
IA054761223G0001X
IA084201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05855OtherDR JOHN MULLEN LICENSE
485525932OtherDR JOHN MULLEN SS
IA0081927Medicaid
IA0499004Medicaid
IA1295196Medicaid
1611620OtherDR BRETT KILBURG UNITED C
1895652OtherDR MELANIE STUNT UNITED C
IA0015818Medicaid
05476OtherDR HEYO TJARKS LICENSE
08217OtherDR BRETT KILBURG LICENSE
08420OtherDR MELANIE STUNT LICENSE
478500357OtherDR HEYO TJARKS SS
0762348OtherDR JOHN MULLEN UNITED CON
480084209OtherDR MELANIE STUNT SS
479026247OtherDR BRETT KILBURG SS