Provider Demographics
NPI:1487342895
Name:STEVEN ROBERT RAYMOND
Entity type:Organization
Organization Name:STEVEN ROBERT RAYMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-542-8484
Mailing Address - Street 1:19223 GREEN HERON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3972
Mailing Address - Country:US
Mailing Address - Phone:225-921-1837
Mailing Address - Fax:
Practice Address - Street 1:15716 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1451
Practice Address - Country:US
Practice Address - Phone:985-542-8484
Practice Address - Fax:985-542-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty