Provider Demographics
NPI:1386742377
Name:DUBE, DANIEL KAI (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KAI
Last Name:DUBE
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 1:5653 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2793
Mailing Address - Country:US
Mailing Address - Phone:910-791-0986
Mailing Address - Fax:910-791-2902
Practice Address - Street 1:5653 CAROLINA BEACH RD
Practice Address - Street 2:SUITE C1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2793
Practice Address - Country:US
Practice Address - Phone:910-791-0986
Practice Address - Fax:910-791-2902
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice