Provider Demographics
NPI:1497974562
Name:RUBEN, GLEN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:SCOTT
Last Name:RUBEN
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 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2707
Mailing Address - Country:US
Mailing Address - Phone:516-944-3400
Mailing Address - Fax:516-944-3403
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2707
Practice Address - Country:US
Practice Address - Phone:516-944-3400
Practice Address - Fax:516-944-3403
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice