Provider Demographics
NPI:1871691758
Name:RUBIS, JOSEPH DAVID (DDS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DAVID
Last Name:RUBIS
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 1:2241 THEODORE ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1881
Mailing Address - Country:US
Mailing Address - Phone:815-741-1700
Mailing Address - Fax:815-741-8511
Practice Address - Street 1:2241 THEODORE ST
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-1881
Practice Address - Country:US
Practice Address - Phone:815-741-1700
Practice Address - Fax:815-741-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist