MEDICARE: ROBERT G KUBO 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	29983	CA

General Provider Information

NPI Number	:	1982348801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G KUBO DDS

Provider Business Mailing Address
First Line	:	6315 N FRESNO ST STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5273
Country	:	US
Telephone Number	:	559-438-7600
Fax Number	:	559-438-6432

Provider Business Practice Location Address
First Line	:	6315 N FRESNO ST STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5273
Country	:	US
Telephone Number	:	559-438-7600
Fax Number	:	559-438-6432

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

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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