Organization
ILSE W. BERUBE, DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILSE WERNER BERUBE DMD (PRESIDENT)
(321) 723-0671
Entity
Organization
Contact information
Practice address
1937 CENTRAL BLVD, MELBOURNE, FL 32901-4205
(321) 723-0671
(321) 723-4454
Mailing address
1937 CENTRAL BLVD, MELBOURNE, FL 32901-4205
(321) 723-0671
(321) 723-4454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14259
FL
Other
Enumeration date
07/01/2009
Last updated
07/01/2009
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