Provider Demographics
NPI:1306958590
Name:CUBANO, VLADIMIR (DMD)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:CUBANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1413
Mailing Address - Country:US
Mailing Address - Phone:518-233-8814
Mailing Address - Fax:
Practice Address - Street 1:108 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1418
Practice Address - Country:US
Practice Address - Phone:518-458-1723
Practice Address - Fax:518-458-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice