Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 106 | FL |
N | 1223D0001X | Dental Public Health | 160 | FL |
NPI | 1750607941 |
---|---|
Provider Name | Dr. Hubert A Lutz |
First Address | Palm Harbor, FL 34683-4940 |
Second Address | Fruitland Park, FL 34731-4497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 13/04/2010 |