Provider Demographics
NPI:1356143424
Name:RUBIN, JUSTIN M (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:RUBIN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CAMDEN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3449
Mailing Address - Country:US
Mailing Address - Phone:770-401-9060
Mailing Address - Fax:
Practice Address - Street 1:12840 RIVERSIDE DR STE 508
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3375
Practice Address - Country:US
Practice Address - Phone:818-506-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist