MEDICARE: DR. CHRISTINE O'ROURKE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	22DI02705300	NJ

General Provider Information

NPI Number	:	1619406493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE O'ROURKE DMD

Provider Business Mailing Address
First Line	:	14 S LINDEN LN
Second Line	:
City	:	PLAINSBORO
State	:	NJ
Zip	:	08536-2506
Country	:	US
Telephone Number	:	201-240-2737
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-3125
Country	:	US
Telephone Number	:	609-799-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	08/07/2022

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