Provider Demographics
NPI:1952468159
Name:KUBECKA, NANCY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:W
Last Name:KUBECKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-6104
Mailing Address - Country:US
Mailing Address - Phone:979-245-6336
Mailing Address - Fax:979-245-9262
Practice Address - Street 1:2417 AVENUE I
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-6104
Practice Address - Country:US
Practice Address - Phone:979-245-6336
Practice Address - Fax:979-245-9262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice