Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 010375 | CT |
Y | 1223P0700X | Prosthodontist | 010375 | CT |
NPI | 1083736219 |
---|---|
Provider Name | Satoko Ono Rubin |
First Address | West Hartford, CT 06107-2140 |
Second Address | South Windsor, CT 06074-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 17/07/2014 |