Provider Demographics
NPI:1407987704
Name:DENTAL INNOVATIONS JAY DUBIN DMD LLC
Entity type:Organization
Organization Name:DENTAL INNOVATIONS JAY DUBIN DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-646-3040
Mailing Address - Street 1:1364 WELSH RD
Mailing Address - Street 2:SUITE F1
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1913
Mailing Address - Country:US
Mailing Address - Phone:215-646-3040
Mailing Address - Fax:
Practice Address - Street 1:1364 WELSH RD
Practice Address - Street 2:SUITE F1
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1913
Practice Address - Country:US
Practice Address - Phone:215-646-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0367011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty