Provider Demographics
NPI:1508002353
Name:LUBAN, MARK ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:LUBAN
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:PO BOX 1872
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-1872
Mailing Address - Country:US
Mailing Address - Phone:858-395-3381
Mailing Address - Fax:858-756-3377
Practice Address - Street 1:17156 EL VUELO
Practice Address - Street 2:1872
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067-1872
Practice Address - Country:US
Practice Address - Phone:858-395-3381
Practice Address - Fax:858-756-3377
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist