Healthcare Provider Details

I. General information

NPI: 1376164236
Provider Name (Legal Business Name): GEORGE RUBIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 ABERCORN ST STE 110
SAVANNAH GA
31405-5833
US

IV. Provider business mailing address

107 CONGO CT
POOLER GA
31322-7035
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-3880
  • Fax:
Mailing address:
  • Phone: 516-647-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN123256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: