Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS-026729-L | PA |
NPI | 1154538361 |
---|---|
Provider Name | Dr. Louis Frank Rubino JR. |
First Address | Phoenixville, PA 19460-3905 |
Second Address | Phoenixville, PA 19460-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |