Individual provider Active NPI

Edward William Kubic Jr., D.D.S.

  • General Practice Dentistry
  • Austintown, OH
National Provider Identifier
1265517692
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30018365 Issued in OH
Practice address
1050 S Canfield Niles Rd
Austintown, OH 44515-4034
Phone
(330) 799-1453
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30018365 OH Primary

Addresses

Primary practice location

1050 S Canfield Niles Rd
Austintown, OH 44515-4034

Mailing address

1050 S Canfield Niles Rd
Austintown, OH 44515-4034
Phone (330) 799-1453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
30018365OHMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265517692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 S CANFIELD NILES RD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445154034",
            "telephone_number": "330-799-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 S CANFIELD NILES RD",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445154034",
            "telephone_number": "330-799-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIC",
        "first_name": "EDWARD",
        "middle_name": "WILLIAM",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30018365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austintown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.