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General NPI Number Information
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NPI Number | 1699818997
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Entity Type | Organization
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Legal Business Name | CONCERNED DENTAL CARE, PC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11901 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2001
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Country | US
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Telephone | 718-843-1616
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Fax | 718-323-2219
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Provider Business Mailing Address
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Address Line | 11901 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2001
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Country | US
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Telephone | 718-843-1616
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Fax | 718-323-2219
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KENNETH HARVEY RUBIN
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Credential | DDS
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Telephone | 718-843-1616
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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 | 031972-3
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 032077-1
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License Number State | NY
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