Provider Demographics
NPI:1255645768
Name:WAGHELA, RACHANA (DDS)
Entity type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:
Last Name:WAGHELA
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 1:1456 31ST DR
Mailing Address - Street 2:APT 5E
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4569
Mailing Address - Country:US
Mailing Address - Phone:816-838-7639
Mailing Address - Fax:
Practice Address - Street 1:1456 31ST DR
Practice Address - Street 2:APT 5E
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4569
Practice Address - Country:US
Practice Address - Phone:816-838-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50055007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist