Provider Demographics
NPI:1720363401
Name:DIWANA, RAJESHWARI (DDS)
Entity Type:Individual
Prefix:
First Name:RAJESHWARI
Middle Name:
Last Name:DIWANA
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 1:603 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3775
Mailing Address - Country:US
Mailing Address - Phone:408-674-1039
Mailing Address - Fax:
Practice Address - Street 1:603 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3775
Practice Address - Country:US
Practice Address - Phone:408-674-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice