Provider Demographics
NPI:1215004577
Name:RATHBUN, JOHN EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWIN
Last Name:RATHBUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 TREAT BLVD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3601
Mailing Address - Country:US
Mailing Address - Phone:925-680-1111
Mailing Address - Fax:925-680-1115
Practice Address - Street 1:2975 TREAT BLVD
Practice Address - Street 2:SUITE E-2
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3601
Practice Address - Country:US
Practice Address - Phone:925-680-1111
Practice Address - Fax:925-680-1115
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice