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General NPI Number Information
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NPI Number | 1831388685
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Entity Type | Individual
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Provider Name | GINA M. TANIOS-RAFLA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 646 HIGHWAY 18 BLDG B SUITE 114
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3722
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Country | US
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Telephone | 732-238-1760
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Fax | 732-390-6169
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Provider Business Mailing Address
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Address Line | 646 HIGHWAY 18 BLDG B SUITE 114
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3722
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Country | US
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Telephone | 732-238-1760
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Fax | 732-390-6169
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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 | 14423
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License Number State | NJ
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