MEDICARE: JOHN S RUBIN, DDS, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1639696891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN S RUBIN, DDS, PA

Provider Business Mailing Address
First Line	:	2600 W 7TH ST STE 184
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-9319
Country	:	US
Telephone Number	:	817-332-5192
Fax Number	:	817-887-0883

Provider Business Practice Location Address
First Line	:	2600 W 7TH ST STE 184
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-9319
Country	:	US
Telephone Number	:	817-332-5192
Fax Number	:	817-887-0883

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN S RUBIN
Credential	:	DDS PA
Telephone Number	:	817-332-5192

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	07/21/2022

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