Provider Demographics
NPI:1225174899
Name:RUBIN, GILBERT I (DDS)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:I
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:84 MAIN ST. SOUTH
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-1088
Mailing Address - Country:US
Mailing Address - Phone:203-263-2853
Mailing Address - Fax:203-263-2864
Practice Address - Street 1:84 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3403
Practice Address - Country:US
Practice Address - Phone:203-263-2853
Practice Address - Fax:203-263-2864
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist