Provider Demographics
NPI:1730392648
Name:GYSELINCK JR, RAYMOND (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GYSELINCK JR
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 1:253 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:DILLARD
Mailing Address - State:GA
Mailing Address - Zip Code:30537-2200
Mailing Address - Country:US
Mailing Address - Phone:706-746-0216
Mailing Address - Fax:706-746-3859
Practice Address - Street 1:253 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:DILLARD
Practice Address - State:GA
Practice Address - Zip Code:30537-2200
Practice Address - Country:US
Practice Address - Phone:706-746-0216
Practice Address - Fax:706-746-3859
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice