Provider Demographics
NPI:1316227655
Name:RUBINSTEIN, SERGIO (DDS)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:RUBINSTEIN
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 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1458
Mailing Address - Country:US
Mailing Address - Phone:847-673-9292
Mailing Address - Fax:847-674-4696
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 420
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:847-673-9292
Practice Address - Fax:847-674-4696
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190202121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice