Provider Demographics
NPI:1215357397
Name:RUBICON CARE NETWORK
Entity Type:Organization
Organization Name:RUBICON CARE NETWORK
Other - Org Name:RUBICON DENTAL ASSOCIATES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-702-1303
Mailing Address - Street 1:2639 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4656
Mailing Address - Country:US
Mailing Address - Phone:406-702-1303
Mailing Address - Fax:406-969-4004
Practice Address - Street 1:10 AVANTA WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6873
Practice Address - Country:US
Practice Address - Phone:406-655-4210
Practice Address - Fax:406-655-8100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUBICON DENTAL ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty