Provider Demographics
NPI:1205990538
Name:RUBASH, CHARLES M (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:RUBASH
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 1:600 S MONROE
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950
Mailing Address - Country:US
Mailing Address - Phone:608-562-5180
Mailing Address - Fax:608-562-3044
Practice Address - Street 1:600 S MONROE
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:WI
Practice Address - Zip Code:53950
Practice Address - Country:US
Practice Address - Phone:608-562-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI027201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice