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General NPI Number Information
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NPI Number | 1508002353
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Entity Type | Individual
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Provider Name | MARK ALAN LUBAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 17156 EL VUELO 1872
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-1872
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Country | US
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Telephone | 858-395-3381
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Fax | 858-756-3377
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Provider Business Mailing Address
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Address Line | PO BOX 1872
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-1872
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Country | US
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Telephone | 858-395-3381
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Fax | 858-756-3377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29358
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License Number State | CA
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