Provider Demographics
NPI:1023898145
Name:RAYMOND COSMETIC & IMPLANT DENTISTRY
Entity type:Organization
Organization Name:RAYMOND COSMETIC & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-728-4997
Mailing Address - Street 1:1251 WESLEY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6443
Mailing Address - Country:US
Mailing Address - Phone:901-332-9170
Mailing Address - Fax:901-332-0806
Practice Address - Street 1:1251 WESLEY DR STE 130
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6443
Practice Address - Country:US
Practice Address - Phone:901-332-9170
Practice Address - Fax:901-332-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty