Provider Demographics
NPI:1164421459
Name:LUBER, JOHN G (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:LUBER
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 1:11867 MASON MONTGOMERY RD
Mailing Address - Street 2:STE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249
Mailing Address - Country:US
Mailing Address - Phone:513-677-0383
Mailing Address - Fax:513-677-1235
Practice Address - Street 1:11867 MASON MONTGOMERY RD
Practice Address - Street 2:STE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-677-0383
Practice Address - Fax:513-677-1235
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist