Provider Demographics
NPI:1073520789
Name:RUBIN, JEFFREY E
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:RUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9680
Mailing Address - Country:US
Mailing Address - Phone:239-370-3343
Mailing Address - Fax:239-320-3288
Practice Address - Street 1:26649 DUBLIN WOODS CIR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7224
Practice Address - Country:US
Practice Address - Phone:239-370-3343
Practice Address - Fax:239-320-3288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12852122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070759700Medicaid