Provider Demographics
NPI:1720147242
Name:RABINOWITZ, IRA (DMD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:RABINOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 VINCENT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1529
Mailing Address - Country:US
Mailing Address - Phone:612-924-9129
Mailing Address - Fax:
Practice Address - Street 1:4959 EXCELSIOR BLVD
Practice Address - Street 2:#200
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3033
Practice Address - Country:US
Practice Address - Phone:952-920-8774
Practice Address - Fax:952-920-8979
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND98231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice