MEDICARE: DR. JACOB RABICHEV DDS

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	122300000X	Dentist	DEN.00205116	CO

General Provider Information

NPI Number	:	1831837905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB RABICHEV DDS

Provider Business Mailing Address
First Line	:	2454 FENTON ST
Second Line	:
City	:	EDGEWATER
State	:	CO
Zip	:	80214-1133
Country	:	US
Telephone Number	:	612-860-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 LARIMER ST STE 880
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1523
Country	:	US
Telephone Number	:	303-534-7797
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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