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General NPI Number Information
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NPI Number | 1164620928
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Entity Type | Individual
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Provider Name | JAMES T DUBOVICK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 53754 MAIN RD
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City | SOUTHOLD
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State | NY
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Zip | 11971
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Country | US
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Telephone | 631-765-1160
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Fax | 631-765-9198
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Provider Business Mailing Address
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Address Line | PO BOX 698
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City | SOUTHOLD
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State | NY
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Zip | 11971
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Country | US
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Telephone | 631-765-1160
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Fax | 631-765-9198
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 029400
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License Number State | NY
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