Keith R Kubiak, D.D.S.

Key facts

NPI

1801949029

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

22302 (TX)

Practice address

165 S Leon St
Giddings, TX 78942-3313

Phone

(979) 542-3696

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Opted out of Medicare

Yes, effective Feb 16, 2016 through Feb 16, 2028

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801949029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 S LEON ST",
            "city": "GIDDINGS",
            "state": "TX",
            "postal_code": "789423313",
            "telephone_number": "979-542-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 S LEON ST",
            "city": "GIDDINGS",
            "state": "TX",
            "postal_code": "789423313",
            "telephone_number": "979-542-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBIAK",
        "first_name": "KEITH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Giddings, TX

• Danielle Jones
• Mark Allen Jones, PT
• Paul A Jurica III, DPT
• Teresa Hill Kinsfather, D.O.
• Anna Marie Kleinschmidt, RPH, REGISTERED PHARMACIS
• Richard Kubiak, D.D.S., F.A.G.D.
• Nichole Kuck, PSYD
• Laura Birnbaum, M.D., P.a.
• Lifecare Corporation
• Deanna Lowrey-Green, LMSW

All providers in Giddings, TX · General Practice Dentistry in Texas