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General NPI Number Information
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NPI Number | 1124161773
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Entity Type | Individual
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Provider Name | MICHAEL R JUBA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 704 N SPLITROCK BLVD
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City | BRANDON
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State | SD
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Zip | 57005
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Country | US
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Telephone | 605-582-7102
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Fax | 605-582-7109
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Provider Business Mailing Address
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Address Line | PO BOX 624
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City | BRANDON
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State | SD
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Zip | 57005-0624
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Country | US
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Telephone | 605-582-7102
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Fax | 605-582-7109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | M-592
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License Number State | SD
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