Provider Demographics
NPI:1093881880
Name:RADEN, ALLAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:A
Last Name:RADEN
Suffix:
Gender:M
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:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028
Mailing Address - Country:US
Mailing Address - Phone:856-582-7007
Mailing Address - Fax:
Practice Address - Street 1:4 MONROE AVE.
Practice Address - Street 2:
Practice Address - City:PITTMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071
Practice Address - Country:US
Practice Address - Phone:856-582-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI14108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist