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General NPI Number Information
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NPI Number | 1720459902
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Entity Type | Organization
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Legal Business Name | WESTSIDE FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 2300 BUFFALO RD BLDG 800A
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City | ROCHESTER
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State | NY
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Zip | 14624-1300
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Country | US
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Telephone | 585-247-1530
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Fax | 585-612-7447
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Provider Business Mailing Address
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Address Line | 2300 BUFFALO RD BLDG 800A
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City | ROCHESTER
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State | NY
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Zip | 14624-1300
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Country | US
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Telephone | 585-247-1530
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Fax | 585-612-7447
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN P LUBES
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Credential | DDS
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Telephone | 585-247-1530
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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 | 041568
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License Number State | NY
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