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General NPI Number Information
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NPI Number | 1447701420
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Entity Type | Organization
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Legal Business Name | GREGORY K. RABITZ, D.D.S., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1600 WILLOW ST STE 250
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City | SAN JOSE
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State | CA
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Zip | 95125-5115
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Country | US
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Telephone | 408-309-4323
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Fax | 408-827-4059
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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 | 408-827-4059
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Authorized Official
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Title or Position | 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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47781
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License Number State | CA
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