Provider Demographics
NPI:1801104807
Name:RABANUS, JORG-PETER
Entity type:Individual
Prefix:DR
First Name:JORG-PETER
Middle Name:
Last Name:RABANUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SPEAR ST
Mailing Address - Street 2:B-16
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1581
Mailing Address - Country:US
Mailing Address - Phone:415-999-6194
Mailing Address - Fax:
Practice Address - Street 1:121 SPEAR ST
Practice Address - Street 2:B-16
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1581
Practice Address - Country:US
Practice Address - Phone:415-999-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice