Provider Demographics
NPI:1881819613
Name:DURST, RUEBEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUEBEN
Middle Name:
Last Name:DURST
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 1:103 BROAD ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3419
Mailing Address - Country:US
Mailing Address - Phone:404-577-4691
Mailing Address - Fax:404-215-9984
Practice Address - Street 1:103 BROAD ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3419
Practice Address - Country:US
Practice Address - Phone:404-577-4691
Practice Address - Fax:404-215-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist