Healthcare Provider Details

I. General information

NPI: 1639817356
Provider Name (Legal Business Name): RUBIN ANTHONY SORRELL II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 REVERE AVE
SAN FRANCISCO CA
94124-2345
US

IV. Provider business mailing address

1739 REVERE AVE
SAN FRANCISCO CA
94124-2345
US

V. Phone/Fax

Practice location:
  • Phone: 415-240-9502
  • Fax:
Mailing address:
  • Phone: 415-240-9502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: