Provider Demographics
NPI:1124641337
Name:KUBLICKIS, RHODA P (MHS, CRDH, FAADH)
Entity type:Individual
Prefix:MRS
First Name:RHODA
Middle Name:P
Last Name:KUBLICKIS
Suffix:
Gender:F
Credentials:MHS, CRDH, FAADH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 TROPIC DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5428
Mailing Address - Country:US
Mailing Address - Phone:954-829-4260
Mailing Address - Fax:
Practice Address - Street 1:274 TROPIC DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5428
Practice Address - Country:US
Practice Address - Phone:954-829-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902872124Q00000X
NJ22HI00397500124Q00000X
FL7119124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist