Provider Demographics
NPI:1902832983
Name:KUSH-LUBAK, MARIA L (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:KUSH-LUBAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:KUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-1821
Mailing Address - Country:US
Mailing Address - Phone:610-562-0424
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 422, SPORTSMAN ROAD
Practice Address - Street 2:BUILDING 37
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029240L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist