MEDICARE: RUBI MARCONI DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841830965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBI MARCONI DDS PLLC

Provider Business Mailing Address
First Line	:	11003 DUMBRECK DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2903
Country	:	US
Telephone Number	:	718-704-3126
Fax Number	:

Provider Business Practice Location Address
First Line	:	4557 E SAM HOUSTON PKWY S STE 160
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3996
Country	:	US
Telephone Number	:	718-704-3126
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUBI MARCONI
Credential	:
Telephone Number	:	718-704-3126

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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