Provider Demographics
NPI:1003037706
Name:DR. S. MARK RAYBURG D.M.D. , INC.
Entity Type:Organization
Organization Name:DR. S. MARK RAYBURG D.M.D. , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RAYBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-335-9835
Mailing Address - Street 1:161 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3428
Mailing Address - Country:US
Mailing Address - Phone:724-335-9835
Mailing Address - Fax:724-335-9836
Practice Address - Street 1:161 ALDER ST
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3428
Practice Address - Country:US
Practice Address - Phone:724-335-9835
Practice Address - Fax:724-335-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021045L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty