Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 47781 | CA |
NPI | 1023007903 |
---|---|
Provider Name | Dr. Gregory Kirk Rabitz |
First Address | San Jose, CA 95128-1647 |
Second Address | San Jose, CA 95128-1647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 23/10/2007 |