Provider Demographics
NPI:1376727891
Name:RUBINSTEIN, BORIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:RUBINSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 2ND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4126
Mailing Address - Country:US
Mailing Address - Phone:215-431-6207
Mailing Address - Fax:
Practice Address - Street 1:159 FORGE LN
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7837
Practice Address - Country:US
Practice Address - Phone:215-431-6207
Practice Address - Fax:215-359-0841
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05544991223G0001X
PADS030054L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
06060915OtherDENTIST