Provider Demographics
NPI:1255431292
Name:RASKIN, BRIAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:RASKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GARDEN CITY PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3301
Mailing Address - Country:US
Mailing Address - Phone:516-825-1100
Mailing Address - Fax:516-825-1258
Practice Address - Street 1:200 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3301
Practice Address - Country:US
Practice Address - Phone:516-825-1100
Practice Address - Fax:516-825-1258
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0368151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice