Provider Demographics
NPI:1659402972
Name:RUBENSTEIN, PETER EVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EVAN
Last Name:RUBENSTEIN
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 1:8800 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238
Mailing Address - Country:US
Mailing Address - Phone:941-966-5603
Mailing Address - Fax:
Practice Address - Street 1:8800 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:SUITE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238
Practice Address - Country:US
Practice Address - Phone:941-966-5603
Practice Address - Fax:941-966-4669
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist