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NPI 1275815664

NPI 1275815664 : CATHERINE LOUISE KUBERA DDS, MS : JACKSONVILLE, FL

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General NPI Number Information
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    NPI Number           |    1275815664
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    Entity Type          |    Individual 
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    Provider Name        |    CATHERINE LOUISE KUBERA DDS, MS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    09/13/2011
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    Last Update Date     |    11/07/2024
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Provider Practice Location Address
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    Address Line         |    2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT COMMAND/ATTN:MEDICALSTAFFSERVICES
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    City                 |    JACKSONVILLE
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    State                |    FL
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    Zip                  |    32212-0140
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    Country              |    US
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    Telephone            |    510-325-6677
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    550 POPE AVE 
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    City                 |    FORT LEAVENWORTH
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    State                |    KS
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    Zip                  |    66027-2332
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    Country              |    US
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    Telephone            |    
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    60587
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    License Number State |    CA
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Taxonomy #2
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    Taxonomy Code        |    1223X0400X
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    Taxonomy Name        |    Orthodontics and Dentofacial Orthopedics Dentistry
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    License Number       |    60587
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    License Number State |    CA
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