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General NPI Number Information
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NPI Number | 1316030349
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Entity Type | Organization
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Legal Business Name | CORAL WEST DENTAL P.C.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 2575 CORAL CT
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City | CORALVILLE
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State | IA
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Zip | 52241-2811
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Country | US
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Telephone | 319-545-2345
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Fax | 319-545-2349
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Provider Business Mailing Address
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Address Line | 2575 CORAL COURT
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City | CORALVILLE
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State | IA
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Zip | 52241
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Country | US
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Telephone | 319-545-2345
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Fax | 319-545-2349
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFEREY EDWARD RUBEL
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Credential | D.D.S
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Telephone | 319-545-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7419
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License Number State | IA
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