Provider Demographics
NPI:1689972648
Name:AZEEM, LUBNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUBNA
Middle Name:
Last Name:AZEEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2904
Mailing Address - Country:US
Mailing Address - Phone:408-396-3544
Mailing Address - Fax:
Practice Address - Street 1:1027 CORVETTE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2904
Practice Address - Country:US
Practice Address - Phone:408-396-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59978122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice