Healthcare Provider Details

I. General information

NPI: 1023007903
Provider Name (Legal Business Name): GREGORY KIRK RABITZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OCONNOR DR SUITE 11
SAN JOSE CA
95128-1647
US

IV. Provider business mailing address

100 OCONNOR DR SUITE 11
SAN JOSE CA
95128-1647
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-0488
  • Fax: 408-287-5455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number47781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: