Provider Demographics
NPI:1821526641
Name:DUBIN, MAX IZAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:IZAK
Last Name:DUBIN
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 1:2333 N TRIPHAMMER RD STE 304
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1075
Mailing Address - Country:US
Mailing Address - Phone:607-272-3433
Mailing Address - Fax:
Practice Address - Street 1:2333 N TRIPHAMMER RD STE 304
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1075
Practice Address - Country:US
Practice Address - Phone:607-272-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0598851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice