Healthcare Provider Details

I. General information

NPI: 1841391364
Provider Name (Legal Business Name): BRIAN CURTISS RUBENS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22232 17TH AVE SE SUITE 209 CANYON PARK OFFICE CENTER
BOTHELL WA
98021-7411
US

IV. Provider business mailing address

22232 17TH AVE SE SUITE 209 CANYON PARK OFFICE CENTER
BOTHELL WA
98021-7411
US

V. Phone/Fax

Practice location:
  • Phone: 425-489-8274
  • Fax: 425-487-9506
Mailing address:
  • Phone: 425-489-8274
  • Fax: 425-487-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE00005479
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberGA10000140
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: