Provider Demographics
NPI:1336240811
Name:MANOV, LUBOMIR Z (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUBOMIR
Middle Name:Z
Last Name:MANOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4930
Mailing Address - Country:US
Mailing Address - Phone:480-239-6305
Mailing Address - Fax:
Practice Address - Street 1:10555 N TATUM BLVD
Practice Address - Street 2:SUITE A-102
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1097
Practice Address - Country:US
Practice Address - Phone:480-607-7444
Practice Address - Fax:480-607-9657
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice