Provider Demographics
NPI:1013066927
Name:KUBELKA, MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KUBELKA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 E 67TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4950
Mailing Address - Country:US
Mailing Address - Phone:918-494-4144
Mailing Address - Fax:918-494-4188
Practice Address - Street 1:4606 E 67TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4950
Practice Address - Country:US
Practice Address - Phone:918-494-4144
Practice Address - Fax:918-494-4188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics