Provider Demographics
NPI:1215092200
Name:SUMAREVA, RADA (DDS)
Entity type:Individual
Prefix:DR
First Name:RADA
Middle Name:
Last Name:SUMAREVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1948
Mailing Address - Country:US
Mailing Address - Phone:201-440-2100
Mailing Address - Fax:201-440-1550
Practice Address - Street 1:45 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1948
Practice Address - Country:US
Practice Address - Phone:201-440-2100
Practice Address - Fax:201-440-1550
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020034001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics