Provider Demographics
NPI:1336409358
Name:LUBBERTS, NICHOLE BRINKMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:BRINKMAN
Last Name:LUBBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 5 MILE RD NE
Mailing Address - Street 2:#202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6516
Mailing Address - Country:US
Mailing Address - Phone:813-951-1716
Mailing Address - Fax:
Practice Address - Street 1:2700 5 MILE RD NE
Practice Address - Street 2:#202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6516
Practice Address - Country:US
Practice Address - Phone:813-951-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19882122300000X
MI2901021313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist