Provider Demographics
NPI:1710965959
Name:LUBOW, RICHARD M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:LUBOW
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4865
Mailing Address - Country:US
Mailing Address - Phone:515-705-8358
Mailing Address - Fax:
Practice Address - Street 1:929 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:515-705-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10141315-99211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10141315-8903OtherPAHARMACY
UT10141315-9921OtherDENTISTRY