Provider Demographics
NPI:1831388685
Name:TANIOS-RAFLA, GINA M (DMD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:TANIOS-RAFLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:646 HIGHWAY 18 BLDG B
Mailing Address - Street 2:SUITE 114
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3722
Mailing Address - Country:US
Mailing Address - Phone:732-238-1760
Mailing Address - Fax:732-390-6169
Practice Address - Street 1:646 HIGHWAY 18 BLDG B
Practice Address - Street 2:SUITE 114
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3722
Practice Address - Country:US
Practice Address - Phone:732-238-1760
Practice Address - Fax:732-390-6169
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist