Provider Demographics
NPI:1588738843
Name:RUBAL, DENIS G (DDS)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:G
Last Name:RUBAL
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 1:401 SOUTH ST.
Mailing Address - Street 2:BLDG. 4A
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2819
Mailing Address - Country:US
Mailing Address - Phone:440-286-9011
Mailing Address - Fax:440-286-3874
Practice Address - Street 1:401 SOUTH ST.
Practice Address - Street 2:BLDG 4A
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2819
Practice Address - Country:US
Practice Address - Phone:440-286-9011
Practice Address - Fax:440-286-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-43281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice