Provider Demographics
NPI:1134258817
Name:LUBEK, JOSHUA ELI (MD , DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ELI
Last Name:LUBEK
Suffix:
Gender:M
Credentials:MD , DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 W BALTIMORE ST
Mailing Address - Street 2:STE. # 1401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-6195
Mailing Address - Fax:410-706-4199
Practice Address - Street 1:650 W BALTIMORE ST
Practice Address - Street 2:STE. # 1401
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-6195
Practice Address - Fax:410-706-4199
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178771223S0112X
MI4301083994204E00000X
MDD64569204E00000X
MD711223S0112X
ORMD29070204E00000X
PAMD431734204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286589Medicaid
ORR000WCKCGOtherMEDICARE PART B