MEDICARE: DR. BRIAN CHARLES DUBIN DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22D100942800	NJ

General Provider Information

NPI Number	:	1700902731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CHARLES DUBIN DMD

Provider Business Mailing Address
First Line	:	33 SOUTHERN HILLS DR
Second Line	:
City	:	SKILLMAN
State	:	NJ
Zip	:	08558-2356
Country	:	US
Telephone Number	:	609-333-1361
Fax Number	:	609-333-1384

Provider Business Practice Location Address
First Line	:	1648 US HIGHWAY 130
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3016
Country	:	US
Telephone Number	:	732-821-7676
Fax Number	:	732-821-6886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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