Healthcare Provider Details

I. General information

NPI: 1891189353
Provider Name (Legal Business Name): LUCAS ROBERT CARUBIA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 MULBERRY ST
SCRANTON PA
18503-1221
US

IV. Provider business mailing address

2450 HODGEN RD
COLORADO SPRINGS CO
80921-1605
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7760
  • Fax:
Mailing address:
  • Phone: 719-640-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS041497
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: