Provider Demographics
NPI:1861950040
Name:RUBIN, LUIS COHEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:COHEN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:
Other - Last Name:COHEN RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1685 HYANNIS-BARNSTABLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630
Mailing Address - Country:US
Mailing Address - Phone:786-918-9535
Mailing Address - Fax:
Practice Address - Street 1:735 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1867
Practice Address - Country:US
Practice Address - Phone:786-918-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL139341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGWUU1UOtherBASIC LIFE SUPPORT FOR HEALTH CARE PROVIDERS