Individual
ALITA DARMAYANTI LUBIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6134 WHITE HORSE RD STE C, GREENVILLE, SC 29611-3847
(864) 295-2744
Mailing address
2253 ASPEN RIDGE CT, JACKSONVILLE, FL 32233-6384
(904) 654-5616
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.10601
SC
Other
Enumeration date
12/19/2022
Last updated
08/02/2023
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