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General NPI Number Information
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NPI Number | 1326222878
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Entity Type | Organization
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Legal Business Name | UNIVERSITY DENTAL CARE LLC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 61 LIVINGSTON AVE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2502
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Country | US
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Telephone | 732-545-1268
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Fax | 732-545-4613
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Provider Business Mailing Address
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Address Line | 61 LIVINGSTON AVE
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2502
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Country | US
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Telephone | 732-545-1268
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Fax | 732-545-4613
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LANNY S RUBIN
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Credential | DDS
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Telephone | 732-545-1268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15155
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License Number State | NJ
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