Active NPI
Koby Scott Sarubin, DDS
- Dentist
- Baltimore, MD
National Provider Identifier
1912358979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16227
- Practice address
- 711 W40Th St
Ste 213
Baltimore, MD 21211 - Phone
- (410) 549-9500
- NPI assigned
- Jun 30, 2016
- Last updated
- Aug 19, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16227 | MD | Primary |
Addresses
Primary practice location
711 W40Th St
Ste 213
Baltimore, MD 21211
Mailing address
711 W40Th St
Ste 213
Baltimore, MD 21211
Phone (410) 889-7100
Other practice location 1
1601 SW Archer Rd
Dental Service (160)
Gainesville, FL 32608-1135
Phone (352) 376-1611 ext. 6335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171128002629 | MD | Order and Referring Only - Dentist | 1759648884 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16227 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Rotunda LLC | Dentist | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787097600000",
"number": "1912358979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 W40TH ST",
"address_2": "STE 213",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21211",
"telephone_number": "410-889-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 W40TH ST",
"address_2": "STE 213",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21211",
"telephone_number": "410-549-9500"
}
],
"practiceLocations": [
{
"address_1": "1601 SW Archer Rd",
"address_2": "Dental Service (160)",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326081135",
"country_code": "US",
"telephone_number": "352-376-1611 x6335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SARUBIN",
"first_name": "KOBY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-30",
"last_updated": "2026-08-19",
"certification_date": "2026-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "16227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.