Provider Demographics
NPI:1447685367
Name:RAIBROWN, ANISHA (RDH)
Entity type:Individual
Prefix:MS
First Name:ANISHA
Middle Name:
Last Name:RAIBROWN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANISHA
Other - Middle Name:
Other - Last Name:RAIBROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:187 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4131
Mailing Address - Country:US
Mailing Address - Phone:781-724-8105
Mailing Address - Fax:
Practice Address - Street 1:187 NEWTON ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4131
Practice Address - Country:US
Practice Address - Phone:781-724-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH88038124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist