Provider Demographics
NPI:1639646995
Name:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH APDLLC
Entity type:Organization
Organization Name:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH APDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-455-4400
Mailing Address - Street 1:8564 JEFFERSON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2424
Mailing Address - Country:US
Mailing Address - Phone:225-927-8663
Mailing Address - Fax:
Practice Address - Street 1:554 COLONIAL DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6552
Practice Address - Country:US
Practice Address - Phone:225-923-2291
Practice Address - Fax:225-923-2325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL P JUBAN DDS AND J CODY COWEN NORTH APDLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty