Provider Demographics
NPI:1124401989
Name:RUBACH, ERIN ELYSSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELYSSA
Last Name:RUBACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELYSSA
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3435 SPRING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2142
Mailing Address - Country:US
Mailing Address - Phone:563-355-7749
Mailing Address - Fax:563-355-9884
Practice Address - Street 1:3435 SPRING ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-355-7749
Practice Address - Fax:563-355-9884
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61228122300000X
IA09512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist