Provider Demographics
NPI:1063416311
Name:DAB, MICHAEL GERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERALD
Last Name:DAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 LAS GALLINAS AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3431
Mailing Address - Country:US
Mailing Address - Phone:415-472-5211
Mailing Address - Fax:415-472-1046
Practice Address - Street 1:750 LAS GALLINAS AVE
Practice Address - Street 2:STE 111
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3431
Practice Address - Country:US
Practice Address - Phone:415-472-5211
Practice Address - Fax:415-472-1046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice