MEDICARE: DR. G DAVID RUBLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901009785	MI

General Provider Information

NPI Number	:	1558364539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. G DAVID RUBLEY DDS

Provider Business Mailing Address
First Line	:	32 DIVISION ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-1966
Country	:	US
Telephone Number	:	517-278-7436
Fax Number	:	517-279-4633

Provider Business Practice Location Address
First Line	:	32 DIVISION ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-1966
Country	:	US
Telephone Number	:	517-278-7436
Fax Number	:	517-279-4633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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