Healthcare Provider Details

I. General information

NPI: 1518992130
Provider Name (Legal Business Name): LORETTA KAREN RUBENSTEIN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 MCMANUS BLVD STE 1B
NEWPORT NEWS VA
23602-4402
US

IV. Provider business mailing address

12725 MCMANUS BLVD STE 1B
NEWPORT NEWS VA
23602-4402
US

V. Phone/Fax

Practice location:
  • Phone: 757-874-0990
  • Fax: 757-874-7819
Mailing address:
  • Phone: 757-874-0990
  • Fax: 757-874-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401005748
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: