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General NPI Number Information
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NPI Number | 1386198356
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Entity Type | Organization
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Legal Business Name | MICHAEL R JUBA DDS INC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 704 N SPLITROCK BLVD
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City | BRANDON
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State | SD
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Zip | 57005-2053
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Country | US
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Telephone | 605-582-7102
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Fax | 605-582-7109
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Provider Business Mailing Address
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Address Line | 704 N SPLITROCK BLVD PO BOX 624
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City | BRANDON
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State | SD
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Zip | 57005-2053
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Country | US
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Telephone | 605-582-7102
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Fax | 605-582-7109
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL JUBA
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Credential | DDS
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Telephone | 605-582-7102
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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 | M592
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License Number State | SD
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