Provider Demographics
NPI:1649466343
Name:LUBBERTS, RAYMOND C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:LUBBERTS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:1240 S WESTLAKE BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-6202
Mailing Address - Country:US
Mailing Address - Phone:805-496-9666
Mailing Address - Fax:805-496-5504
Practice Address - Street 1:1240 S WESTLAKE BLVD STE 235
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-6202
Practice Address - Country:US
Practice Address - Phone:805-496-9666
Practice Address - Fax:805-496-5504
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADR0285711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics