Provider Demographics
NPI:1396815403
Name:LUBTZ, MARK TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TODD
Last Name:LUBTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 HWY 206
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502
Mailing Address - Country:US
Mailing Address - Phone:908-874-5100
Mailing Address - Fax:908-874-0921
Practice Address - Street 1:2230 HWY 206
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502
Practice Address - Country:US
Practice Address - Phone:908-874-5100
Practice Address - Fax:908-874-0921
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI147381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice