Healthcare Provider Details

I. General information

NPI: 1790859643
Provider Name (Legal Business Name): RUBINS,VAGIANOS,TOLMIE & CORSIG, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 RANDOLPH RD SUITE 103-R
CHARLOTTE NC
28211-1032
US

IV. Provider business mailing address

3535 RANDOLPH RD SUITE 103-R
CHARLOTTE NC
28211-1032
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-0123
  • Fax: 704-364-8640
Mailing address:
  • Phone: 704-365-0123
  • Fax: 704-364-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0377
License Number StateNC

VIII. Authorized Official

Name: ROBERT P. RUBINS
Title or Position: PRESIDENT
Credential: DDS
Phone: 704-365-0123