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General NPI Number Information
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NPI Number | 1902206725
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER JOUBERT DDS PC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 250 PATCHOGUE YAPHANK RD SUITE 9
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4800
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Country | US
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Telephone | 631-475-3400
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Fax | 631-475-3465
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Provider Business Mailing Address
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Address Line | 250 PATCHOGUE YAPHANK RD SUITE 9
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4800
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Country | US
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Telephone | 631-475-3400
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Fax | 631-475-3465
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER JOUBERT
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Credential | DDS
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Telephone | 631-404-5261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 055176-1
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License Number State | NY
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