Provider Demographics
NPI:1629417381
Name:LUBIN, VICTOR DARIEN
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:DARIEN
Last Name:LUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:DARIEN
Other - Last Name:LUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6544 SW 57TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3679
Mailing Address - Country:US
Mailing Address - Phone:786-444-2884
Mailing Address - Fax:
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4368
Practice Address - Country:US
Practice Address - Phone:239-433-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist