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General NPI Number Information
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NPI Number | 1003255084
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Entity Type | Individual
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Provider Name | ISHRAT RANGWALA DMD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | WILBUR PECK COURT
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City | GREENWICH
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State | CT
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Zip | 06830
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Country | US
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Telephone | 646-379-6675
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Fax | 646-379-6675
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Provider Business Mailing Address
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Address Line | 212 ROGER AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-1776
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Country | US
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Telephone | 646-379-6768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02544400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10962
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License Number State | CT
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