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General NPI Number Information
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NPI Number | 1174814115
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Entity Type | Individual
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Provider Name | DANA MARIE KUBINSKI RDH
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Gender | Female
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 43401 N JEFFERSON AVE BLDG 825
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City | SELFRIDGE ANGB
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State | MI
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Zip | 48045-5266
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Country | US
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Telephone | 586-239-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 3332 17TH ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-6110
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Country | US
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Telephone | 734-778-5106
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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 | 2902014312
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License Number State | MI
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