Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN21753 | FL |
NPI | 1023351715 |
---|---|
Provider Name | Dr. Shelly Levin-Rubin |
First Address | Coral Springs, FL 33076-2987 |
Second Address | Boca Raton, FL 33433-2390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100364300 | (05) | FL |