Provider Demographics
NPI:1104006022
Name:MAUREEN M. RACKZKA AND TIMOTHY C. RACZKA DDS, PA
Entity Type:Organization
Organization Name:MAUREEN M. RACKZKA AND TIMOTHY C. RACZKA DDS, PA
Other - Org Name:ALLIANCE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RACZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-363-3100
Mailing Address - Street 1:202 DAVIS GROVE CIR
Mailing Address - Street 2:STE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-2505
Mailing Address - Country:US
Mailing Address - Phone:919-363-3100
Mailing Address - Fax:919-363-3002
Practice Address - Street 1:202 DAVIS GROVE CIR
Practice Address - Street 2:STE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-2505
Practice Address - Country:US
Practice Address - Phone:919-363-3100
Practice Address - Fax:919-363-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty