Provider Demographics
NPI:1770887044
Name:RABACH, MARTIN MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MITCHELL
Last Name:RABACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2309
Mailing Address - Country:US
Mailing Address - Phone:203-234-0500
Mailing Address - Fax:203-234-0555
Practice Address - Street 1:12 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2309
Practice Address - Country:US
Practice Address - Phone:203-234-0500
Practice Address - Fax:203-234-0555
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics