Stacey Jill Lubetsky, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DTP663 Issued in FL

Practice address

4800 Lakewood Ranch Blvd
Bradenton, FL 34211-4953

Phone

(941) 405-1553

NPI assigned

Jan 14, 2007

Last updated

Mar 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1285785626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11914 PERENNIAL PL",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342113220",
            "telephone_number": "732-233-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 LAKEWOOD RANCH BLVD",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342114953",
            "telephone_number": "941-405-1553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 Robert Pitt Dr",
            "address_purpose": "LOCATION",
            "city": "Monsey",
            "state": "NY",
            "postal_code": "109523333",
            "country_code": "US",
            "telephone_number": "732-233-0037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUBETSKY",
        "first_name": "STACEY",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-14",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "050066",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02284400",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DTP663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Lozada
• LP Bradenton LLC (Heritage Park Care & Rehabilitation Center)
• LT Dental Group, PLLC (Dream Smile Dental)
• Ltsu Healthcare Services LLC
• Yang Jun Lu, MD
• Cory Lucas, NP
• Jacqueline Ann Lucas, APRN
• Heather H Lucero, ARNP
• Dana Marie Lucy, DMD
• Adrian Lugo

• Pediatric Dentistry in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.