Provider Demographics
NPI:1700111903
Name:LUBA, MARIA ISABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:LUBA
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 1:664 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1502
Mailing Address - Country:US
Mailing Address - Phone:973-868-1126
Mailing Address - Fax:
Practice Address - Street 1:639 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3109
Practice Address - Country:US
Practice Address - Phone:973-481-3900
Practice Address - Fax:973-481-2999
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI024209001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0214647Medicaid