Provider Demographics
NPI:1801040399
Name:LUBA, KEVIN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:LUBA
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 1:11965 SW BENNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2721
Mailing Address - Country:US
Mailing Address - Phone:954-673-2926
Mailing Address - Fax:
Practice Address - Street 1:1449 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1968
Practice Address - Country:US
Practice Address - Phone:772-348-4409
Practice Address - Fax:772-348-4344
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice