Provider Demographics
NPI:1881982320
Name:RUBIN, COURTNEY ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:RUBIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WALNUT ST
Mailing Address - Street 2:APT 620
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5552
Mailing Address - Country:US
Mailing Address - Phone:516-428-5173
Mailing Address - Fax:
Practice Address - Street 1:211 GEIGER RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1009
Practice Address - Country:US
Practice Address - Phone:215-676-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN 207181223X0400X
PADS0406361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program