Provider Demographics
NPI:1619990330
Name:RATHBAUER, JOHN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:RATHBAUER
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 1:32 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4132
Mailing Address - Country:US
Mailing Address - Phone:631-424-2214
Mailing Address - Fax:
Practice Address - Street 1:32 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4132
Practice Address - Country:US
Practice Address - Phone:631-424-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist