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General NPI Number Information
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NPI Number | 1972839553
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTAL OF LOMBARD PC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 845 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3350
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Country | US
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Telephone | 630-620-1980
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Fax | 815-483-2298
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Provider Business Mailing Address
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Address Line | 845 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3350
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Country | US
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Telephone | 630-620-1980
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Fax | 815-483-2298
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J RUBIS
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Credential | DDS
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Telephone | 630-620-1980
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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 | 019026816
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License Number State | IL
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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 | 019016447
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License Number State | IL
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