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General NPI Number Information
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NPI Number | 1376908731
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Entity Type | Organization
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Legal Business Name | DR RABITZ PEDIATRIC DENTAL OFFICE
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 15827 LOS GATOS BLVD STE B
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City | LOS GATOS
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State | CA
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Zip | 95032-3300
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Country | US
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Telephone | 408-356-4900
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Fax | 408-356-4997
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Provider Business Mailing Address
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Address Line | 15466 LOS GATOS BLVD # 109218
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City | LOS GATOS
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State | CA
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Zip | 95032-2542
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Country | US
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Telephone | 408-309-4323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | DR. GREGORY KIRK RABITZ
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Credential | D.D.S.
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Telephone | 408-309-4323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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