Provider Demographics
NPI:1144302035
Name:SUBKA, JACQUELINE L (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:L
Last Name:SUBKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HAALAND DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-373-1919
Mailing Address - Fax:805-373-2083
Practice Address - Street 1:425 HAALAND DR
Practice Address - Street 2:SUITE 202
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-373-1919
Practice Address - Fax:805-373-2083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist