| Picasso Aesthetic And Cosmetic Dental Spa Pa | |
|
26649 Dublin Woods Circle Jeffrey Rubin Bonita Springs FL 34135 | |
| (239) 370-3343 | |
| (239) 320-3288 |
| Full Name | Picasso Aesthetic And Cosmetic Dental Spa Pa |
|---|---|
| Speciality | Dentist |
| Location | 26649 Dublin Woods Circle, Bonita Springs, Florida |
| Authorized Official Name and Position | Jeffrey Rubin (PRESIDENT) |
| Authorized Official Contact | 2393703343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Picasso Aesthetic And Cosmetic Dental Spa Pa 18302 Ridgeline Dr Estero FL 33928-9680 Ph: (239) 370-3343 | Picasso Aesthetic And Cosmetic Dental Spa Pa 26649 Dublin Woods Circle Jeffrey Rubin Bonita Springs FL 34135 Ph: (239) 370-3343 |
| NPI Number | 1205182276 |
|---|---|
| Provider Enumeration Date | 07/27/2012 |
| Last Update Date | 08/03/2023 |
| Medicare PECOS PAC ID | 5294034682 |
|---|---|
| Medicare Enrollment ID | O20160506001043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205182276 | NPI | - | NPPES |
| 070759700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN12852 (Florida) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Rubin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1073520789 PECOS PAC ID: 6103125596 Enrollment ID: I20160513000790 |
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