Provider Demographics
NPI:1023060787
Name:WRUBLE, LLOYD LUSTIG (DMD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:LUSTIG
Last Name:WRUBLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7706
Mailing Address - Country:US
Mailing Address - Phone:305-670-7610
Mailing Address - Fax:305-670-4950
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:STE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-7610
Practice Address - Fax:305-670-4950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN50051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96597Medicare UPIN
FL84662Medicare ID - Type Unspecified