Provider Demographics
NPI:1154355048
Name:KUBIKIAN, LOUIZA (DDS)
Entity type:Individual
Prefix:DR
First Name:LOUIZA
Middle Name:
Last Name:KUBIKIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LOUIZA
Other - Middle Name:
Other - Last Name:PUSKULIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 COACHMAN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3119
Mailing Address - Country:US
Mailing Address - Phone:516-248-2955
Mailing Address - Fax:718-729-8688
Practice Address - Street 1:4334 43RD ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2608
Practice Address - Country:US
Practice Address - Phone:718-786-3842
Practice Address - Fax:718-729-8688
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist