Provider Demographics
NPI:1154415388
Name:LUBOVICH, RONALD PETER (DDS, MSD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:PETER
Last Name:LUBOVICH
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 BRANSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3102
Mailing Address - Country:US
Mailing Address - Phone:615-297-5577
Mailing Address - Fax:615-292-1319
Practice Address - Street 1:2828 BRANSFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3102
Practice Address - Country:US
Practice Address - Phone:615-297-5577
Practice Address - Fax:615-292-1319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000019761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT7441Medicare UPIN
TN3225457Medicare ID - Type UnspecifiedMEDICARE