Provider Demographics
NPI:1851057616
Name:RABBIT CREEK DENTAL, PLLC
Entity Type:Organization
Organization Name:RABBIT CREEK DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:GEGZNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-308-0584
Mailing Address - Street 1:4371 RIVER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9570
Mailing Address - Country:US
Mailing Address - Phone:251-533-7103
Mailing Address - Fax:
Practice Address - Street 1:5000 RANGELINE CROSSING BLVD. STE D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9517
Practice Address - Country:US
Practice Address - Phone:251-533-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental