Provider Demographics
NPI:1407954746
Name:RATHBURN, WILLFRED EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLFRED
Middle Name:EUGENE
Last Name:RATHBURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:EUGENE
Other - Last Name:RATHBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3909 VAN BUREN BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-688-4520
Mailing Address - Fax:951-688-3701
Practice Address - Street 1:3909 VAN BUREN BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-688-4520
Practice Address - Fax:951-688-3701
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18264122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics