Provider Demographics
NPI:1013118124
Name:MICHIO KUBOTA D.D.S. INC.
Entity Type:Organization
Organization Name:MICHIO KUBOTA D.D.S. INC.
Other - Org Name:HARMONY DENTAL OF AZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHIO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-632-2255
Mailing Address - Street 1:694 S COOPER RD
Mailing Address - Street 2:SUITE #A-2
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7165
Mailing Address - Country:US
Mailing Address - Phone:480-632-2255
Mailing Address - Fax:480-632-7846
Practice Address - Street 1:694 S COOPER RD
Practice Address - Street 2:SUITE #A-2
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7165
Practice Address - Country:US
Practice Address - Phone:480-632-2255
Practice Address - Fax:480-632-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD44171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty