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NPI Code Detail

MEDICARE: SOUTHEASTERN DENTAL ASSOCIATES V, PA

MEDICARE: SOUTHEASTERN DENTAL ASSOCIATES V, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN0002214FL

General Provider Information

NPI Number : 1295977585
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN DENTAL ASSOCIATES V, PA
Provider Business Mailing Address
First Line : 1160 KANE CONCOURSE
Second Line : SUITE # 203
City : BAL HARBOUR
State : FL
Zip : 33154
Country : US
Telephone Number : 305-866-7127
Fax Number :
Provider Business Practice Location Address
First Line : 1160 KANE CONCOURSE
Second Line : SUITE # 203
City : BAL HARBOUR
State : FL
Zip : 33154
Country : US
Telephone Number : 305-866-7127
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. KENNETH D RUBINSTEIN
Credential : DMD
Telephone Number : 305-866-7127
Provider Enumeration Date : 04/01/2009
Last Update Date : 04/01/2009

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Directions to “SOUTHEASTERN DENTAL ASSOCIATES V, PA ” Practice Location

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