Provider Demographics
NPI:1821200759
Name:DUBIN, GARY KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KARL
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 1:652 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2719
Mailing Address - Country:US
Mailing Address - Phone:203-453-4346
Mailing Address - Fax:203-453-4347
Practice Address - Street 1:652 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2719
Practice Address - Country:US
Practice Address - Phone:203-453-4346
Practice Address - Fax:203-453-4347
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice