Provider Demographics
NPI:1003177502
Name:RUBANO, COLLEEN (RDH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:RUBANO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PATTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4232
Mailing Address - Country:US
Mailing Address - Phone:203-640-9231
Mailing Address - Fax:
Practice Address - Street 1:58 PATTON DR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4232
Practice Address - Country:US
Practice Address - Phone:203-640-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005848124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist