Provider Demographics
NPI:1699835058
Name:KUBILIUS, CHRISTIAN DON (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:DON
Last Name:KUBILIUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 S HARLEM AV
Mailing Address - Street 2:STE 102
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-361-5353
Mailing Address - Fax:708-361-5320
Practice Address - Street 1:11950 S HARLEM AV
Practice Address - Street 2:STE 102
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-361-5353
Practice Address - Fax:708-361-5320
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILK142104553661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice