Provider Demographics
NPI:1003934233
Name:RUBIN, TODD BARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:BARRY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:TODD
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:210 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1743
Mailing Address - Country:US
Mailing Address - Phone:860-561-2065
Mailing Address - Fax:
Practice Address - Street 1:469 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3737
Practice Address - Country:US
Practice Address - Phone:860-644-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT092721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice