Provider Demographics
NPI:1689082984
Name:SRIVASTAVA, RASHMI (DDS)
Entity Type:Individual
Prefix:
First Name:RASHMI
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N LADOW AVE
Mailing Address - Street 2:APT # 12J
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1475
Mailing Address - Country:US
Mailing Address - Phone:626-710-3459
Mailing Address - Fax:
Practice Address - Street 1:1103 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6915
Practice Address - Country:US
Practice Address - Phone:626-710-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025804001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice