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General NPI Number Information
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NPI Number | 1437319860
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Entity Type | Organization
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Legal Business Name | RUBIN DENTAL PRACTICE
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 469 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3737
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Country | US
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Telephone | 860-644-2136
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Fax | 860-644-2217
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Provider Business Mailing Address
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Address Line | 469 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3737
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Country | US
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Telephone | 860-644-2136
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Fax | 860-644-2217
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TODD BARRY RUBIN
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Credential | D.M.D.
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Telephone | 860-644-2136
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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 | 04599
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License Number State | CT
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