Provider Demographics
NPI:1699971820
Name:KAPUSTA, RUBIA GRECCO MENEGAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:RUBIA
Middle Name:GRECCO MENEGAZ
Last Name:KAPUSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8143
Mailing Address - Country:US
Mailing Address - Phone:601-749-9330
Mailing Address - Fax:601-749-9449
Practice Address - Street 1:6480 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8143
Practice Address - Country:US
Practice Address - Phone:601-749-9330
Practice Address - Fax:601-749-9449
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3257031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice