Provider Demographics
NPI:1992110928
Name:JUBER, SHANE M (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:M
Last Name:JUBER
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 1:226 E ROCKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-5573
Mailing Address - Country:US
Mailing Address - Phone:801-372-8396
Mailing Address - Fax:
Practice Address - Street 1:14 N HALE ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029
Practice Address - Country:US
Practice Address - Phone:435-884-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6427587-99231223G0001X
CODEN.002025651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice