Provider Demographics
NPI:1386198356
Name:MICHAEL R JUBA DDS INC
Entity type:Organization
Organization Name:MICHAEL R JUBA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-582-7102
Mailing Address - Street 1:704 N SPLITROCK BLVD
Mailing Address - Street 2:PO BOX 624
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-2053
Mailing Address - Country:US
Mailing Address - Phone:605-582-7102
Mailing Address - Fax:605-582-7109
Practice Address - Street 1:704 N SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-2053
Practice Address - Country:US
Practice Address - Phone:605-582-7102
Practice Address - Fax:605-582-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty