MEDICARE: RT. 1 DENTAL, INC

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	1223G0001X	General Practice Dentistry	20092	NJ

General Provider Information

NPI Number	:	1205856671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RT. 1 DENTAL, INC

Provider Business Mailing Address
First Line	:	2229 US HIGHWAY 1
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4402
Country	:	US
Telephone Number	:	732-940-0222
Fax Number	:	732-940-5532

Provider Business Practice Location Address
First Line	:	2229 US HIGHWAY 1
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4402
Country	:	US
Telephone Number	:	732-940-0222
Fax Number	:	732-940-5532

Authorized Official
Title or Position	:	PRES
Name	:	DR. IRENE TRAKHTMAN
Credential	:	DDS
Telephone Number	:	732-940-0222

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/22/2020

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