Provider Demographics
NPI:1598204497
Name:GREG RUBIN DDS
Entity Type:Organization
Organization Name:GREG RUBIN DDS
Other - Org Name:1000 SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-454-1000
Mailing Address - Street 1:1000 NEWBURY RD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6435
Mailing Address - Country:US
Mailing Address - Phone:805-454-1000
Mailing Address - Fax:805-738-5530
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 138
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-454-1000
Practice Address - Fax:805-738-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710049457Medicaid