MEDICARE: JAMES A. KOUBA, D.D.S., P.C.

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	1223G0001X	General Practice Dentistry	06138	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588707921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES A. KOUBA, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	107 S PINE ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1519
Country	:	US
Telephone Number	:	641-664-1121
Fax Number	:	641-664-2107

Provider Business Practice Location Address
First Line	:	107 S PINE ST
Second Line	:
City	:	BLOOMFIELD
State	:	IA
Zip	:	52537-1519
Country	:	US
Telephone Number	:	641-664-1121
Fax Number	:	641-664-2107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES A KOUBA
Credential	:	D.D.S.
Telephone Number	:	641-664-1121

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/22/2020

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