Individual provider Active NPI

John M. Rubenstrunk, D.D.S.,M.S

  • Pediatric Dentistry
  • Centennial, CO
National Provider Identifier
1912004383
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
8110 Issued in CO
Practice address
9094 E. Mineral Ave.
#240
Centennial, CO 80112-7200
Phone
(303) 799-1872
Fax
(303) 799-3760
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 8110 CO Primary

Addresses

Primary practice location

9094 E. Mineral Ave.
#240
Centennial, CO 80112-7200

Mailing address

9094 E. Mineral Ave.
#240
Centennial, CO 80112-7200
Phone (303) 799-1872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
8110COMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Southmoor Pediatric Dentistry Pediatric Dentistry Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1912004383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9094 E. MINERAL AVE.",
            "address_2": "#240",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801127200",
            "telephone_number": "303-799-1872",
            "fax_number": "303-799-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9094 E. MINERAL AVE.",
            "address_2": "#240",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801127200",
            "telephone_number": "303-799-1872",
            "fax_number": "303-799-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBENSTRUNK",
        "first_name": "JOHN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "8110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centennial, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.