Provider Demographics
NPI:1720459902
Name:WESTSIDE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WESTSIDE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUBES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-247-1530
Mailing Address - Street 1:2300 BUFFALO RD BLDG 800A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1300
Mailing Address - Country:US
Mailing Address - Phone:585-247-1530
Mailing Address - Fax:585-612-7447
Practice Address - Street 1:2300 BUFFALO RD BLDG 800A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1300
Practice Address - Country:US
Practice Address - Phone:585-247-1530
Practice Address - Fax:585-612-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty