Provider Demographics
NPI:1104433549
Name:VIJ, RUCHIEKA (DMD)
Entity type:Individual
Prefix:
First Name:RUCHIEKA
Middle Name:
Last Name:VIJ
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 1:202 KATAHDIN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6437
Mailing Address - Country:US
Mailing Address - Phone:857-284-2329
Mailing Address - Fax:
Practice Address - Street 1:314 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5202
Practice Address - Country:US
Practice Address - Phone:857-284-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist