Provider Demographics
NPI:1841296308
Name:LUBITZ, RICHARD B (DMO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:LUBITZ
Suffix:
Gender:F
Credentials:DMO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MONMOUTH RD
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1021
Mailing Address - Country:US
Mailing Address - Phone:732-389-1110
Mailing Address - Fax:732-389-1662
Practice Address - Street 1:107 MONMOUTH RD
Practice Address - Street 2:STE 107
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1021
Practice Address - Country:US
Practice Address - Phone:732-389-1110
Practice Address - Fax:732-389-1662
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01094100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist