Provider Demographics
NPI:1518070614
Name:RACZKA, TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:RACZKA
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 1:202 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice