Provider Demographics
NPI:1457728826
Name:TANEJA, RUCHEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUCHEE
Middle Name:
Last Name:TANEJA
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 1:205 BROADWAY
Mailing Address - Street 2:SUITE #8,9
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1046
Mailing Address - Country:US
Mailing Address - Phone:978-258-0970
Mailing Address - Fax:978-258-1893
Practice Address - Street 1:205 BROADWAY
Practice Address - Street 2:SUITE #8,9
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1046
Practice Address - Country:US
Practice Address - Phone:978-258-0970
Practice Address - Fax:978-258-1893
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice