Provider Demographics
NPI:1760574867
Name:LUBCZUK, ANDRZEJ (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:LUBCZUK
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 1:9193 SIERRA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4776
Mailing Address - Country:US
Mailing Address - Phone:909-822-2226
Mailing Address - Fax:909-822-2384
Practice Address - Street 1:9193 SIERRA AVE STE D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4776
Practice Address - Country:US
Practice Address - Phone:909-822-2226
Practice Address - Fax:909-822-2384
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist