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General NPI Number Information
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NPI Number | 1699949131
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN DENTAL ASSOCIATES IV, PA
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1800 N FEDERAL HWY SUITE 103
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1034
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Country | US
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Telephone | 954-946-7980
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Fax | 954-946-2206
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Provider Business Mailing Address
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Address Line | 1800 N FEDERAL HWY SUITE 103
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1034
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Country | US
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Telephone | 954-946-7980
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Fax | 954-946-2206
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KENNETH D RUBINSTEIN
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Credential | D.M.D.
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Telephone | 954-946-7980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN 14485
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License Number State | FL
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