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General NPI Number Information
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NPI Number | 1669866455
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTAL & ORTHODONTICS OF CARLINVILLE, PC
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 201 MCCAUSLAND ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-9128
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Country | US
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Telephone | 217-854-4059
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Fax | 217-854-9518
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Provider Business Mailing Address
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Address Line | 201 MCCAUSLAND STREET
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City | CARLINVILLE
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State | IL
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Zip | 62626
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Country | US
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Telephone | 217-854-4059
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Fax | 217-854-9518
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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 | 217-854-4059
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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 | 019016447
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License Number State | IL
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