Provider Demographics
NPI:1730247594
Name:RUBIN, LAURENCE HUGH (DDS MSD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:HUGH
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 N SHEFFIELD AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5191
Mailing Address - Country:US
Mailing Address - Phone:773-929-2628
Mailing Address - Fax:773-929-3385
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5191
Practice Address - Country:US
Practice Address - Phone:773-929-2628
Practice Address - Fax:773-929-3385
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics