Provider Demographics
NPI:1871844480
Name:LUBE, MEGEN M (RDH)
Entity Type:Individual
Prefix:
First Name:MEGEN
Middle Name:M
Last Name:LUBE
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 1:582 MAITLAND DR
Mailing Address - Street 2:APT 80
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3680
Mailing Address - Country:US
Mailing Address - Phone:715-456-6633
Mailing Address - Fax:
Practice Address - Street 1:582 MAITLAND DR
Practice Address - Street 2:APT 80
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3680
Practice Address - Country:US
Practice Address - Phone:715-456-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10778-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist