Provider Demographics
NPI:1023239597
Name:KUBO, WES (DDS)
Entity type:Individual
Prefix:
First Name:WES
Middle Name:
Last Name:KUBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 MID CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2430
Mailing Address - Country:US
Mailing Address - Phone:817-571-2100
Mailing Address - Fax:817-519-8269
Practice Address - Street 1:458 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2430
Practice Address - Country:US
Practice Address - Phone:817-571-2100
Practice Address - Fax:817-519-8269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice