MEDICARE: DR. HAROLD A LUBICK D.D.S., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	28035	CA

General Provider Information

NPI Number	:	1417958190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD A LUBICK D.D.S., M.D.

Provider Business Mailing Address
First Line	:	500 E OLIVE AVE
Second Line	:	SUITE #440
City	:	BURBANK
State	:	CA
Zip	:	91501-3316
Country	:	US
Telephone Number	:	818-848-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E OLIVE AVE
Second Line	:	SUITE #440
City	:	BURBANK
State	:	CA
Zip	:	91501-3316
Country	:	US
Telephone Number	:	818-848-5591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/10/2007

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