Provider Demographics
NPI:1083197222
Name:DUBEROWSKI, SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:DUBEROWSKI
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16913 PIPER LN
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2918
Mailing Address - Country:US
Mailing Address - Phone:218-851-3617
Mailing Address - Fax:
Practice Address - Street 1:16913 PIPER LN
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2918
Practice Address - Country:US
Practice Address - Phone:218-851-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice