Provider Demographics
NPI:1962416941
Name:KUBICEK, RICHARD DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
Last Name:KUBICEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRIEND
Mailing Address - State:NE
Mailing Address - Zip Code:68359-1134
Mailing Address - Country:US
Mailing Address - Phone:402-947-5111
Mailing Address - Fax:
Practice Address - Street 1:920 2ND ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1134
Practice Address - Country:US
Practice Address - Phone:402-947-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076363200Medicaid