Provider Demographics
NPI:1770679979
Name:RUBINSTEIN, MAHRA B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHRA
Middle Name:B
Last Name:RUBINSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MAHRA
Other - Middle Name:B
Other - Last Name:SHOCKET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:362 IVES ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3929
Mailing Address - Country:US
Mailing Address - Phone:401-861-4358
Mailing Address - Fax:401-421-9124
Practice Address - Street 1:362 IVES ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3929
Practice Address - Country:US
Practice Address - Phone:401-861-4358
Practice Address - Fax:401-421-9124
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI26741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050357383OtherTAX ID NUMBER