Provider Demographics
NPI:1003925199
Name:DOMASICA, RITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:DOMASICA
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 1:99 GRAYROCK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1076
Mailing Address - Country:US
Mailing Address - Phone:908-638-5242
Mailing Address - Fax:908-638-8262
Practice Address - Street 1:99 GRAYROCK RD STE 204
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1076
Practice Address - Country:US
Practice Address - Phone:908-638-5242
Practice Address - Fax:908-638-8262
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019712001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice