Provider Demographics
NPI:1851623912
Name:JUBIC, LORRAINE KAY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:KAY
Last Name:JUBIC
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 S SIFFORD CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2843
Mailing Address - Country:US
Mailing Address - Phone:719-547-0505
Mailing Address - Fax:
Practice Address - Street 1:1630 FORTINO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1856
Practice Address - Country:US
Practice Address - Phone:719-545-2468
Practice Address - Fax:719-545-0815
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2203124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist