MEDICARE: MR. DAVID THEOPHIL KUBES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D8622	MN

General Provider Information

NPI Number	:	1205027851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID THEOPHIL KUBES DDS

Provider Business Mailing Address
First Line	:	91 N SNELLING AVE
Second Line	:	SUITE 120
City	:	ST PAUL
State	:	MN
Zip	:	55104-6756
Country	:	US
Telephone Number	:	651-644-9000
Fax Number	:	651-644-0613

Provider Business Practice Location Address
First Line	:	91 N SNELLING AVE
Second Line	:	SUITE 120
City	:	ST PAUL
State	:	MN
Zip	:	55104-6756
Country	:	US
Telephone Number	:	651-644-9000
Fax Number	:	651-644-0613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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