Provider Demographics
NPI:1700262474
Name:POOJARY, RAKSHA (DMD)
Entity type:Individual
Prefix:
First Name:RAKSHA
Middle Name:
Last Name:POOJARY
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 1:56 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2010
Mailing Address - Country:US
Mailing Address - Phone:201-469-6221
Mailing Address - Fax:
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02609800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist