Provider Demographics
NPI:1356345144
Name:KOUBA, JAMES A (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:KOUBA
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 1:107 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1519
Mailing Address - Country:US
Mailing Address - Phone:641-664-1121
Mailing Address - Fax:641-664-2107
Practice Address - Street 1:107 S PINE ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1519
Practice Address - Country:US
Practice Address - Phone:641-664-1121
Practice Address - Fax:641-664-2107
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist