1669701272 NPI number — RAYNOR DENTAL PLLC

Table of content: (NPI 1669701272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669701272 NPI number — RAYNOR DENTAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYNOR DENTAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669701272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 COURT ST
Provider Second Line Business Mailing Address:
UNIT 4
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-1799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-352-0006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 COURT ST
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-352-0006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RAYNOR
Authorized Official First Name:
JASON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
603-352-0006

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3727 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184119075 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com