Provider Demographics
NPI:1417186891
Name:RABE, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RABE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12930 PARK XING
Mailing Address - Street 2:APT 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1667
Mailing Address - Country:US
Mailing Address - Phone:304-444-1927
Mailing Address - Fax:304-444-1927
Practice Address - Street 1:12930 PARK XING
Practice Address - Street 2:APT 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1667
Practice Address - Country:US
Practice Address - Phone:304-444-1927
Practice Address - Fax:304-444-1927
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXXXXXXXXXXXXXX1223G0001X
TX249751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice