MEDICARE: DR. STANLEY DUBIN DDS

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	DS015618-L	PA

General Provider Information

NPI Number	:	1780715433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY DUBIN DDS

Provider Business Mailing Address
First Line	:	535 REVERE RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1032
Country	:	US
Telephone Number	:	215-632-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 SECANE DR
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-1329
Country	:	US
Telephone Number	:	215-632-1244
Fax Number	:

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

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

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