Provider Demographics
NPI:1144456203
Name:MICHAEL D TSUBOTA DDS LLC
Entity type:Organization
Organization Name:MICHAEL D TSUBOTA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TSUBOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-337-9199
Mailing Address - Street 1:109 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-3406
Mailing Address - Country:US
Mailing Address - Phone:201-337-9199
Mailing Address - Fax:201-337-6428
Practice Address - Street 1:109 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3406
Practice Address - Country:US
Practice Address - Phone:201-337-9199
Practice Address - Fax:201-337-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO1395900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty