Provider Demographics
NPI:1730200072
Name:RAYNOR, BOBBY CARLYLE (DDS)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:CARLYLE
Last Name:RAYNOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:1018 HIGHWAY 70 WEST BUILDING 2 102
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-0365
Mailing Address - Country:US
Mailing Address - Phone:919-772-5991
Mailing Address - Fax:919-773-1501
Practice Address - Street 1:1018 HWY 70 WEST
Practice Address - Street 2:BUILDING 2 102
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-0365
Practice Address - Country:US
Practice Address - Phone:919-772-5991
Practice Address - Fax:919-773-1501
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU48659Medicare UPIN