Provider Demographics
NPI:1316249592
Name:SOUTHEASTERN DENTAL ASSOCIATES VI
Entity type:Organization
Organization Name:SOUTHEASTERN DENTAL ASSOCIATES VI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-738-9007
Mailing Address - Street 1:1843 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3417
Mailing Address - Country:US
Mailing Address - Phone:305-643-3040
Mailing Address - Fax:305-643-3371
Practice Address - Street 1:1843 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3417
Practice Address - Country:US
Practice Address - Phone:305-643-3040
Practice Address - Fax:305-643-3371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN DENTAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty