Provider Demographics
NPI:1861695926
Name:RABUN, HENRY E JR (DMD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:E
Last Name:RABUN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:HANK
Other - Middle Name:ELWYNE
Other - Last Name:RABUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2926 PROFESSIONAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-860-0575
Mailing Address - Fax:706-860-4186
Practice Address - Street 1:2926 PROFESSIONAL PARKWAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-860-0575
Practice Address - Fax:706-860-4186
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI003246628Medicaid