MEDICARE: DR. VICTOR DARIEN LUBIN

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	122300000X	Dentist	DN 20118	FL

General Provider Information

NPI Number	:	1629417381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR DARIEN LUBIN

Provider Business Mailing Address
First Line	:	6544 SW 57TH AVE APT 1
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3679
Country	:	US
Telephone Number	:	786-444-2884
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 DIAMOND CENTRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4368
Country	:	US
Telephone Number	:	239-433-4746
Fax Number	:

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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