Provider Demographics
NPI:1962518597
Name:GABUS, JAN C (DDS)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:GABUS
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 1:1300 UNIVERSITY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4254
Mailing Address - Country:US
Mailing Address - Phone:650-325-7711
Mailing Address - Fax:650-325-7715
Practice Address - Street 1:1300 UNIVERSITY DR STE 5
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4254
Practice Address - Country:US
Practice Address - Phone:650-325-7711
Practice Address - Fax:650-325-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice