MEDICARE: SOUTH EASTERN DENTAL ASSOC VI, 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
1	1223P0300X	Periodontics	DN14485	FL

General Provider Information

NPI Number	:	1487985255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH EASTERN DENTAL ASSOC VI, PA

Provider Business Mailing Address
First Line	:	1843 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3417
Country	:	US
Telephone Number	:	305-643-3040
Fax Number	:	305-643-3371

Provider Business Practice Location Address
First Line	:	1843 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3417
Country	:	US
Telephone Number	:	305-643-3040
Fax Number	:	305-643-3371

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH D RUBINSTEIN
Credential	:	D.M.D.
Telephone Number	:	305-866-7127

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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