Provider Demographics
NPI:1245679448
Name:ADVANCED FMAILY DENTAL & ORTHODONTICS, P.C.
Entity type:Organization
Organization Name:ADVANCED FMAILY DENTAL & ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-741-1700
Mailing Address - Street 1:3510 HOBSON RD STE 302
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1442
Mailing Address - Country:US
Mailing Address - Phone:815-741-1700
Mailing Address - Fax:815-483-2298
Practice Address - Street 1:3510 HOBSON RD STE 302
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1442
Practice Address - Country:US
Practice Address - Phone:815-741-1700
Practice Address - Fax:815-483-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty