Provider Demographics
NPI:1174339394
Name:FREDERICK M JOUBERT DDS PLLC
Entity type:Organization
Organization Name:FREDERICK M JOUBERT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-544-9199
Mailing Address - Street 1:3135 SPRINGBANK LN STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3361
Mailing Address - Country:US
Mailing Address - Phone:704-544-9199
Mailing Address - Fax:704-543-7343
Practice Address - Street 1:3135 SPRINGBANK LN STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3361
Practice Address - Country:US
Practice Address - Phone:704-554-9199
Practice Address - Fax:704-543-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental