Provider Demographics
NPI:1548222466
Name:VARGHESE-VALLIYIL, REENA MERLINE (DMD, MSED, MSC)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:MERLINE
Last Name:VARGHESE-VALLIYIL
Suffix:
Gender:F
Credentials:DMD, MSED, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 ROUTE 73 STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5113
Mailing Address - Country:US
Mailing Address - Phone:856-533-0060
Mailing Address - Fax:
Practice Address - Street 1:1120 ROUTE 73 STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-5113
Practice Address - Country:US
Practice Address - Phone:856-533-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022989001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics