MEDICARE: GREGORY K. RABITZ, D.D.S., A PROFESSIONAL CORPORATION

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	261QD0000X	Dental Clinic/Center	47781	CA

General Provider Information

NPI Number	:	1447701420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY K. RABITZ, D.D.S., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	15466 LOS GATOS BLVD
Second Line	:	#109218
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2542
Country	:	US
Telephone Number	:	408-309-4323
Fax Number	:	408-827-4059

Provider Business Practice Location Address
First Line	:	1600 WILLOW ST
Second Line	:	STE 250
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5115
Country	:	US
Telephone Number	:	408-309-4323
Fax Number	:	408-827-4059

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GREGORY KIRK RABITZ
Credential	:	D.D.S.
Telephone Number	:	408-309-4323

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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