Nicholas Anthony Kubik, DDS
Individual provider Active NPI Dentist · Tama, IA
NPI 1689754285 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689754285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 06785 (IA)
- Practice address
- 1311 McClellan St
Tama, IA 52339 - Phone
- (641) 484-5561
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151026000892 | IA | Order and Referring Only - Dentist |
7911216361 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 06785 | IA | Yes |
Addresses
Primary practice location
1311 McClellan St
Tama, IA 52339
Mailing address
PO Box 418
Tama, IA 52339-0418
Phone (641) 484-5561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0195735 | Medicaid | IA |
Other providers in Tama, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.