Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS0000001976 | TN |
NPI | 1154415388 |
---|---|
Provider Name | Ronald Peter Lubovich |
First Address | Nashville, TN 37204-3102 |
Second Address | Nashville, TN 37204-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T7441 | (02) | TN |