Provider Demographics
NPI:1245080019
Name:RASKIN, GAVRIEL (DMD)
Entity type:Individual
Prefix:
First Name:GAVRIEL
Middle Name:
Last Name:RASKIN
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 1:382 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3336
Mailing Address - Country:US
Mailing Address - Phone:845-376-0674
Mailing Address - Fax:
Practice Address - Street 1:6418 BERGENLINE AVE FL 2
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1621
Practice Address - Country:US
Practice Address - Phone:201-868-6400
Practice Address - Fax:201-868-6400
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI031183001223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice