Provider Demographics
NPI:1003255084
Name:RANGWALA, ISHRAT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISHRAT
Middle Name:
Last Name:RANGWALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ROGER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1776
Mailing Address - Country:US
Mailing Address - Phone:646-379-6768
Mailing Address - Fax:
Practice Address - Street 1:WILBUR PECK COURT
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:646-379-6675
Practice Address - Fax:646-379-6675
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02544400122300000X
CT10962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist