Provider Demographics
NPI:1326114471
Name:JACK DUBIN DMD INC
Entity Type:Organization
Organization Name:JACK DUBIN DMD INC
Other - Org Name:DENTAL CARE WESTGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-379-7700
Mailing Address - Street 1:1600 SARATOGA AVE
Mailing Address - Street 2:613
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5101
Mailing Address - Country:US
Mailing Address - Phone:408-379-7700
Mailing Address - Fax:408-866-8153
Practice Address - Street 1:1600 SARATOGA AVE
Practice Address - Street 2:613
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5101
Practice Address - Country:US
Practice Address - Phone:408-379-7700
Practice Address - Fax:408-866-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1223G0001XOtherGENERAL PRACTICE