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General NPI Number Information
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NPI Number | 1538362215
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Entity Type | Organization
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Legal Business Name | JOAN VAN RAALTE D.M.D.,PC
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1943
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Country | US
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Telephone | 973-746-5532
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Fax | 413-677-0904
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Provider Business Mailing Address
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Address Line | 41 WATCHUNG PLZ #185
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4117
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Country | US
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Telephone | 973-746-5532
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Fax | 413-677-0904
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOAN VAN RAALTE
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Credential | D.M.D.
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Telephone | 973-746-5532
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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 | 22DI01926304
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License Number State | NJ
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