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General NPI Number Information
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NPI Number | 1235212101
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Entity Type | Individual
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Provider Name | REBECCA LASH RUBIN DMD
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6177 ORCHARD LAKE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2388
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Country | US
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Telephone | 248-851-7272
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Fax | 248-855-5555
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Provider Business Mailing Address
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Address Line | 26317 HUMBER ST
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1221
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Country | US
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Telephone | 248-546-6689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901018243
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License Number State | MI
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