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General NPI Number Information
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NPI Number | 1487837225
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Entity Type | Organization
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Legal Business Name | BRIAN S. KUBO, DDS, INC.
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 64-5191 KINOHOU ST
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City | KAMUELA
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State | HI
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Zip | 96743-8408
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Country | US
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Telephone | 808-885-8465
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Fax | 808-885-8470
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Provider Business Mailing Address
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Address Line | 64-5191 KINOHOU ST
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City | KAMUELA
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State | HI
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Zip | 96743-8408
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Country | US
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Telephone | 808-885-8465
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Fax | 808-885-8470
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN SEIGO KUBO
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Credential | DDS
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Telephone | 808-885-8465
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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 | DT-1795
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License Number State | HI
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