Healthcare Provider Details

I. General information

NPI: 1962405829
Provider Name (Legal Business Name): ALAN RASKAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SPLIT ROCK DR STE 10
CHERRY HILL NJ
08003-1244
US

IV. Provider business mailing address

523 BRIAN DR
CHERRY HILL NJ
08003-3007
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-3335
  • Fax: 856-424-8753
Mailing address:
  • Phone: 856-795-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI00874100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: