Provider Demographics
NPI:1447701420
Name:GREGORY K. RABITZ, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GREGORY K. RABITZ, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:RABITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-309-4323
Mailing Address - Street 1:15466 LOS GATOS BLVD
Mailing Address - Street 2:#109218
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2542
Mailing Address - Country:US
Mailing Address - Phone:408-309-4323
Mailing Address - Fax:408-827-4059
Practice Address - Street 1:1600 WILLOW ST
Practice Address - Street 2:STE 250
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5115
Practice Address - Country:US
Practice Address - Phone:408-309-4323
Practice Address - Fax:408-827-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47781261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental