Provider Demographics
NPI:1558575613
Name:DUBIN, JACK E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:E
Last Name:DUBIN
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 1:1600 SARATOGA AVE STE 613
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5109
Mailing Address - Country:US
Mailing Address - Phone:408-379-7700
Mailing Address - Fax:
Practice Address - Street 1:1600 SARATOGA AVE STE 613
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5109
Practice Address - Country:US
Practice Address - Phone:408-379-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice