Provider Demographics
NPI:1912027897
Name:RACHUBA, DONNA (DMD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:RACHUBA
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 1:117 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1437
Mailing Address - Country:US
Mailing Address - Phone:609-254-2229
Mailing Address - Fax:
Practice Address - Street 1:301 DAWSON ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2420
Practice Address - Country:US
Practice Address - Phone:856-231-7560
Practice Address - Fax:856-273-9330
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist