Healthcare Provider Details

I. General information

NPI: 1134258817
Provider Name (Legal Business Name): JOSHUA ELI LUBEK M.D. , D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST STE. # 1401
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

650 W BALTIMORE ST STE. # 1401
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-6195
  • Fax: 410-706-4199
Mailing address:
  • Phone: 410-706-6195
  • Fax: 410-706-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017877
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301083994
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD64569
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number71
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD29070
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD431734
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: