Provider Demographics
NPI:1760558282
Name:RAKOSKY OBER, GINA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:RAKOSKY OBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:PAGAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 FAYETTE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012
Mailing Address - Country:US
Mailing Address - Phone:724-929-3368
Mailing Address - Fax:724-929-3467
Practice Address - Street 1:144 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1130
Practice Address - Country:US
Practice Address - Phone:724-938-7101
Practice Address - Fax:724-938-8467
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031328L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10287498600001Medicaid
PA529406OtherUCCI