Healthcare Provider Details

I. General information

NPI: 1477573715
Provider Name (Legal Business Name): PRACTICE OF FAMILY AND COSMETIC DENTISTRY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN ST STE 2
ASHLAND MA
01721
US

IV. Provider business mailing address

30 MAIN ST STE 2
ASHLAND MA
01721
US

V. Phone/Fax

Practice location:
  • Phone: 508-881-4266
  • Fax: 508-881-3983
Mailing address:
  • Phone: 508-881-4266
  • Fax: 508-881-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. MARC F RUBIN
Title or Position: OWNER
Credential:
Phone: 508-881-4266