Provider Demographics
NPI:1851442297
Name:LUBRITZ, KENNETH MICHAEL (D DS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:LUBRITZ
Suffix:
Gender:M
Credentials:D DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FONDREN RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2319
Mailing Address - Country:US
Mailing Address - Phone:713-789-7676
Mailing Address - Fax:713-789-7051
Practice Address - Street 1:2500 FONDREN RD
Practice Address - Street 2:SUITE 330
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2319
Practice Address - Country:US
Practice Address - Phone:713-789-7676
Practice Address - Fax:713-789-7051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics