Provider Demographics
NPI:1669866455
Name:ADVANCED FAMILY DENTAL & ORTHODONTICS OF CARLINVILLE, PC
Entity Type:Organization
Organization Name:ADVANCED FAMILY DENTAL & ORTHODONTICS OF CARLINVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-854-4059
Mailing Address - Street 1:201 MCCAUSLAND STREET
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626
Mailing Address - Country:US
Mailing Address - Phone:217-854-4059
Mailing Address - Fax:217-854-9518
Practice Address - Street 1:201 MCCAUSLAND ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9128
Practice Address - Country:US
Practice Address - Phone:217-854-4059
Practice Address - Fax:217-854-9518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED FAMILY DENTAL & ORTHODONTICS OF MT OLIVE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty