Provider Demographics
NPI:1063609030
Name:RABINOVICH, ALEXANDER (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:RABINOVICH
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6336
Mailing Address - Country:US
Mailing Address - Phone:646-456-1146
Mailing Address - Fax:
Practice Address - Street 1:9655 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6336
Practice Address - Country:US
Practice Address - Phone:646-456-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488501223S0112X
CAA102021204E00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48850OtherDENTAL LICENSE
CAA102021OtherMEDICAL LICENSE
NY246279OtherMEDICAL LICENSE