Provider Demographics
NPI:1295859320
Name:RABADAM, MARYJEAN TRIPON (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARYJEAN
Middle Name:TRIPON
Last Name:RABADAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9170 ELKGROVE -FLORIN RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELKGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624
Mailing Address - Country:US
Mailing Address - Phone:916-686-2888
Mailing Address - Fax:916-405-3436
Practice Address - Street 1:9170 ELKGROVE -FLORIN RD.
Practice Address - Street 2:SUITE D
Practice Address - City:ELKGROVE
Practice Address - State:CA
Practice Address - Zip Code:95624
Practice Address - Country:US
Practice Address - Phone:916-686-2888
Practice Address - Fax:916-405-3436
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice