Provider Demographics
NPI:1780715433
Name:DUBIN, STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:DUBIN
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 1:535 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1032
Mailing Address - Country:US
Mailing Address - Phone:215-632-1244
Mailing Address - Fax:
Practice Address - Street 1:2901 SECANE DR
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19154-1329
Practice Address - Country:US
Practice Address - Phone:215-632-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015618-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice