Provider Demographics
NPI:1578682829
Name:RASKANSKY, LINDA (DMD,)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RASKANSKY
Suffix:
Gender:F
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8279 W LAKE PLEASANT PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7434
Mailing Address - Country:US
Mailing Address - Phone:623-878-0120
Mailing Address - Fax:623-825-6820
Practice Address - Street 1:8279 W LAKE PLEASANT PKWY STE 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7434
Practice Address - Country:US
Practice Address - Phone:623-878-0120
Practice Address - Fax:623-825-6820
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist