Healthcare Provider Details

I. General information

NPI: 1316249592
Provider Name (Legal Business Name): SOUTHEASTERN DENTAL ASSOCIATES VI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1843 SW 8TH ST
MIAMI FL
33135-3417
US

IV. Provider business mailing address

1843 SW 8TH ST
MIAMI FL
33135-3417
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-3040
  • Fax: 305-643-3371
Mailing address:
  • Phone: 305-643-3040
  • Fax: 305-643-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18585
License Number StateFL

VIII. Authorized Official

Name: DR. KENNETH RUBINSTEIN
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 561-738-9007