Provider Demographics
NPI:1336458033
Name:PICKWORTH, RACHEL EMMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:EMMA
Last Name:PICKWORTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:721 N BEERS ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1500
Mailing Address - Country:US
Mailing Address - Phone:732-851-8500
Mailing Address - Fax:732-851-8501
Practice Address - Street 1:721 N BEERS ST STE 2A
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-851-8500
Practice Address - Fax:732-851-8501
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
NJ22DI023017001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies