Healthcare Provider Details

I. General information

NPI: 1861690901
Provider Name (Legal Business Name): LKRUBENSTEIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
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: DR. LORETTA KAREN RUBENSTEIN
Title or Position: DOCTOR/OWNER
Credential: D.D.S.
Phone: 757-874-0990