Provider Demographics
NPI:1760531008
Name:DUBIN, WAYNE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:M
Last Name:DUBIN
Suffix:
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 1:6385 PRESIDENTIAL CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3547
Mailing Address - Country:US
Mailing Address - Phone:239-454-1661
Mailing Address - Fax:239-454-7232
Practice Address - Street 1:6385 PRESIDENTIAL CT
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3547
Practice Address - Country:US
Practice Address - Phone:239-454-1661
Practice Address - Fax:239-454-7232
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00086441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics