=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407056385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. MICHAEL A. KUBINIEC DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 07/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 WASHINGTON AVE
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-343-5865
-----------------------------------------------------
Fax | 585-343-5719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 WASHINGTON AVE
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-343-5865
-----------------------------------------------------
Fax | 585-343-5719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | DR. MICHAEL AUSTIN KUBINIEC
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 585-343-5865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 041012
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------