Provider Demographics
NPI:1376908731
Name:DR RABITZ PEDIATRIC DENTAL OFFICE
Entity Type:Organization
Organization Name:DR RABITZ PEDIATRIC DENTAL OFFICE
Other - Org Name:LOS GATOS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PEDIATRIC 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 # 109218
Mailing Address - Street 2:
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:
Practice Address - Street 1:15827 LOS GATOS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3300
Practice Address - Country:US
Practice Address - Phone:408-356-4900
Practice Address - Fax:408-356-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty