Provider Demographics
NPI:1285093799
Name:RATHAUSER, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:RATHAUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08553-0515
Mailing Address - Country:US
Mailing Address - Phone:908-334-8924
Mailing Address - Fax:908-904-0340
Practice Address - Street 1:25 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-5524
Practice Address - Country:US
Practice Address - Phone:908-334-8924
Practice Address - Fax:908-904-0340
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI149971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics