Provider Demographics
NPI:1487422309
Name:CR DENTAL LOUNGE LLC
Entity type:Organization
Organization Name:CR DENTAL LOUNGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAGHEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-844-4982
Mailing Address - Street 1:266 CINDY ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3013
Mailing Address - Country:US
Mailing Address - Phone:201-844-4982
Mailing Address - Fax:
Practice Address - Street 1:53 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:201-844-4982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental