Provider Demographics
NPI:1992766828
Name:RUBANYI, JANA RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:RAE
Last Name:RUBANYI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANA
Other - Middle Name:RAE
Other - Last Name:MASTRODDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1701 E THOMAS RD
Mailing Address - Street 2:STE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7675
Mailing Address - Country:US
Mailing Address - Phone:602-253-6600
Mailing Address - Fax:602-733-6480
Practice Address - Street 1:1904 W PARKSIDE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1228
Practice Address - Country:US
Practice Address - Phone:623-434-9343
Practice Address - Fax:623-321-6268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD62141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975774Medicaid