Healthcare Provider Details

I. General information

NPI: 1952947541
Provider Name (Legal Business Name): NICOLE RAKHNAYEV DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 MONMOUTH RD
WRIGHTSTOWN NJ
08562-2128
US

IV. Provider business mailing address

226 DORCHESTER DR APT K10
EAST WINDSOR NJ
08512-1437
US

V. Phone/Fax

Practice location:
  • Phone: 609-758-2244
  • Fax:
Mailing address:
  • Phone: 781-801-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02774800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: