Provider Demographics
NPI:1720197403
Name:LUBBE, DAVID PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:LUBBE
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 1:1739 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2721
Mailing Address - Country:US
Mailing Address - Phone:812-273-6744
Mailing Address - Fax:812-265-4025
Practice Address - Street 1:1739 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2721
Practice Address - Country:US
Practice Address - Phone:812-273-6744
Practice Address - Fax:812-265-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81741223P0221X
KY38531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
678416OtherUNITED CONCORDIA
IN200527470-AMedicaid