Provider Demographics
NPI:1912907874
Name:RABE, RANDALL CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CHARLES
Last Name:RABE
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 1:550 SE BASELINE ST
Mailing Address - Street 2:HILLSBORO
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4114
Mailing Address - Country:US
Mailing Address - Phone:503-648-3912
Mailing Address - Fax:503-648-0463
Practice Address - Street 1:550 SE BASELINE ST
Practice Address - Street 2:HILLSBORO
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4114
Practice Address - Country:US
Practice Address - Phone:503-648-3912
Practice Address - Fax:503-648-0463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice