Provider Demographics
NPI:1275284226
Name:RAPHA DENTAL LLC
Entity Type:Organization
Organization Name:RAPHA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOCK IN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-829-8668
Mailing Address - Street 1:700 ROUTE 130 N STE 204
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3366
Mailing Address - Country:US
Mailing Address - Phone:856-829-8668
Mailing Address - Fax:856-314-5682
Practice Address - Street 1:700 ROUTE 130 N STE 204
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3366
Practice Address - Country:US
Practice Address - Phone:856-829-8668
Practice Address - Fax:856-314-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental