MEDICARE: RENATA ALEKHNOVICH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	22DI02657900	NJ

General Provider Information

NPI Number	:	1093160251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA ALEKHNOVICH DMD

Provider Business Mailing Address
First Line	:	341 TIMBER HILL DR
Second Line	:
City	:	MORGANVILLE
State	:	NJ
Zip	:	07751-1678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2064 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2014
Country	:	US
Telephone Number	:	732-637-9805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	02/23/2025

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