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NPI Code Detail

MEDICARE: DR. RUEBEN DURST D.D.S.

MEDICARE:  DR. RUEBEN  DURST  D.D.S.
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
1122300000XDentistDN009417GA

General Provider Information

NPI Number : 1881819613
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUEBEN DURST D.D.S.
Provider Business Mailing Address
First Line : 103 BROAD ST SW
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3419
Country : US
Telephone Number : 404-577-4691
Fax Number : 404-215-9984
Provider Business Practice Location Address
First Line : 103 BROAD ST SW
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3419
Country : US
Telephone Number : 404-577-4691
Fax Number : 404-215-9984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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Directions to “ DR. RUEBEN DURST D.D.S.” Practice Location

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