Provider Demographics
NPI:1396930855
Name:RUBINO, HADLEY A (DMD)
Entity type:Individual
Prefix:DR
First Name:HADLEY
Middle Name:A
Last Name:RUBINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HADLEY
Other - Middle Name:A
Other - Last Name:CREECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:218 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1915
Mailing Address - Country:US
Mailing Address - Phone:973-744-1912
Mailing Address - Fax:973-744-5955
Practice Address - Street 1:218 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1915
Practice Address - Country:US
Practice Address - Phone:973-744-1912
Practice Address - Fax:973-744-5955
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023494001223X0400X
MA205641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics