Provider Demographics
NPI:1992858146
Name:KUBIAK, RICHARD (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KUBIAK
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S LEON ST
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-3313
Mailing Address - Country:US
Mailing Address - Phone:979-542-3696
Mailing Address - Fax:
Practice Address - Street 1:165 S LEON ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-3313
Practice Address - Country:US
Practice Address - Phone:979-542-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice