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General NPI Number Information
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NPI Number | 1164802179
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTAL & ORTHODONTICS
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 2215 THEODORE ST
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City | CREST HILL
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State | IL
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Zip | 60403-5854
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Country | US
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Telephone | 815-741-1700
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Fax | 815-483-2298
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Provider Business Mailing Address
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Address Line | 2215 THEODORE ST
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City | CREST HILL
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State | IL
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Zip | 60403-5854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID RUBIS
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Credential | DDS
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Telephone | 815-741-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019016447
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License Number State | IL
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