MEDICARE: ROBERT RABE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	XXXXXXXXXXXXX	TX
2	1223G0001X	General Practice Dentistry	24975	TX

General Provider Information

NPI Number	:	1417186891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RABE DMD

Provider Business Mailing Address
First Line	:	12930 PARK XING
Second Line	:	APT 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1667
Country	:	US
Telephone Number	:	304-444-1927
Fax Number	:	304-444-1927

Provider Business Practice Location Address
First Line	:	12930 PARK XING
Second Line	:	APT 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1667
Country	:	US
Telephone Number	:	304-444-1927
Fax Number	:	304-444-1927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	03/21/2013

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