Provider Demographics
NPI:1396836821
Name:MELENDEZ-BORIA, RAFAEL (DDS)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MELENDEZ-BORIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 FEDERAL STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-541-5933
Mailing Address - Fax:856-541-3340
Practice Address - Street 1:817 FEDERAL STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-541-5933
Practice Address - Fax:856-541-3340
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02236200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0089290Medicare ID - Type Unspecified