MEDICARE: DR. IRENE TRAKTHMAN DDS

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	:	1750301131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE TRAKTHMAN DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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