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General NPI Number Information
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NPI Number | 1124641337
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Entity Type | Individual
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Provider Name | RHODA P KUBLICKIS MHS, CRDH, FAADH
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Gender | Female
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 274 TROPIC DR
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-5428
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Country | US
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Telephone | 954-829-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 274 TROPIC DR
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-5428
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Country | US
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Telephone | 954-829-4260
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 902872
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 22HI00397500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 7119
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License Number State | FL
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