Provider Demographics
NPI:1740376094
Name:MAHRA B. RUBINSTEIN, DDS & ROBERT J. DUCOFF, DMD, INC.
Entity type:Organization
Organization Name:MAHRA B. RUBINSTEIN, DDS & ROBERT J. DUCOFF, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUCOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-861-4358
Mailing Address - Street 1:362 IVES ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3929
Mailing Address - Country:US
Mailing Address - Phone:401-861-4358
Mailing Address - Fax:401-421-9124
Practice Address - Street 1:362 IVES ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3929
Practice Address - Country:US
Practice Address - Phone:401-861-4358
Practice Address - Fax:401-421-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI=========OtherTAX ID NUMBER