Provider Demographics
NPI:1831212679
Name:RUBIN, MARSHALL BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:BRUCE
Last Name:RUBIN
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 1:1950 EAST MAIN STREET
Mailing Address - Street 2:STE 203
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1268
Mailing Address - Country:US
Mailing Address - Phone:914-528-0078
Mailing Address - Fax:914-528-0583
Practice Address - Street 1:1950 EAST MAIN STREET
Practice Address - Street 2:STE 203
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1268
Practice Address - Country:US
Practice Address - Phone:914-528-0078
Practice Address - Fax:914-528-0583
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3794511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics