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General NPI Number Information
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NPI Number | 1144456203
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Entity Type | Organization
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Legal Business Name | MICHAEL D TSUBOTA DDS LLC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 109 FRANKLIN AVE
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City | OAKLAND
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State | NJ
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Zip | 07436-3406
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Country | US
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Telephone | 201-337-9199
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Fax | 201-337-6428
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Provider Business Mailing Address
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Address Line | 109 FRANKLIN AVE
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City | OAKLAND
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State | NJ
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Zip | 07436-3406
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Country | US
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Telephone | 201-337-9199
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Fax | 201-337-6428
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Authorized Official
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Title or Position | SOLE MBR
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Name | MICHAEL D TSUBOTA
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Credential | D.D.S.
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Telephone | 201-337-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DIO1395900
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License Number State | NJ
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