Provider Demographics
NPI:1174747430
Name:VIROST, RAYMOND PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PAUL
Last Name:VIROST
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 1:307 W PLUM ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1053
Mailing Address - Country:US
Mailing Address - Phone:937-378-6138
Mailing Address - Fax:937-378-9168
Practice Address - Street 1:307 W PLUM ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1053
Practice Address - Country:US
Practice Address - Phone:937-378-6138
Practice Address - Fax:937-378-9168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-55301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice