Provider Demographics
NPI:1154538791
Name:LUBLIN, THEODORE ABRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ABRAHAM
Last Name:LUBLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6025
Mailing Address - Country:US
Mailing Address - Phone:718-531-2300
Mailing Address - Fax:718-531-8457
Practice Address - Street 1:6820 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6025
Practice Address - Country:US
Practice Address - Phone:718-531-2300
Practice Address - Fax:718-531-8457
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0240961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice