Provider Demographics
NPI:1902915598
Name:KUBA, MICHAEL CYRIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CYRIL
Last Name:KUBA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CAPRI BLVD
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1026
Mailing Address - Country:US
Mailing Address - Phone:727-367-8685
Mailing Address - Fax:727-525-5739
Practice Address - Street 1:3301 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2145
Practice Address - Country:US
Practice Address - Phone:727-525-2664
Practice Address - Fax:727-525-5739
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice