Provider Demographics
NPI:1548686678
Name:RAJNICEK, ANNE M (RDH)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:RAJNICEK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 HICKORY KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9362
Mailing Address - Country:US
Mailing Address - Phone:262-719-3410
Mailing Address - Fax:
Practice Address - Street 1:3915 HICKORY KNOLL RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9362
Practice Address - Country:US
Practice Address - Phone:262-719-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5849-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist