Healthcare Provider Details

I. General information

NPI: 1912940685
Provider Name (Legal Business Name): DALE RUBINCHIK D.D.S., INC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 WOODSIDE RD
REDWOOD CITY CA
94061-3611
US

IV. Provider business mailing address

902 WOODSIDE RD
REDWOOD CITY CA
94061-3611
US

V. Phone/Fax

Practice location:
  • Phone: 650-365-8982
  • Fax: 650-365-8928
Mailing address:
  • Phone: 650-365-8982
  • Fax: 650-365-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: