Provider Demographics
NPI:1639696891
Name:JOHN S RUBIN, DDS, PA
Entity Type:Organization
Organization Name:JOHN S RUBIN, DDS, PA
Other - Org Name:MONTGOMERY PLAZA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:817-332-5192
Mailing Address - Street 1:2600 W 7TH ST STE 184
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-9319
Mailing Address - Country:US
Mailing Address - Phone:817-332-5192
Mailing Address - Fax:817-887-0883
Practice Address - Street 1:2600 W 7TH ST STE 184
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-9319
Practice Address - Country:US
Practice Address - Phone:817-332-5192
Practice Address - Fax:817-887-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty