Provider Demographics
NPI:1003820671
Name:RUBIN, MITCHELL MYLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:MYLES
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 MAPLE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-766-0580
Mailing Address - Fax:516-766-6755
Practice Address - Street 1:24 MAPLE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-766-0580
Practice Address - Fax:516-766-6755
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035166122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery