Provider Demographics
NPI:1639817356
Name:SORRELL, RUBIN ANTHONY II (DDS)
Entity Type:Individual
Prefix:
First Name:RUBIN
Middle Name:ANTHONY
Last Name:SORRELL
Suffix:II
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 1:1739 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2345
Mailing Address - Country:US
Mailing Address - Phone:415-240-9502
Mailing Address - Fax:
Practice Address - Street 1:1739 REVERE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2345
Practice Address - Country:US
Practice Address - Phone:415-240-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist