Provider Demographics
NPI:1023024585
Name:RAYMOND, RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 290
Mailing Address - Street 2:139 MARKET STREET SUITE 107
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743
Mailing Address - Country:US
Mailing Address - Phone:207-834-3907
Mailing Address - Fax:207-834-3908
Practice Address - Street 1:139 MARKET STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743
Practice Address - Country:US
Practice Address - Phone:207-834-3907
Practice Address - Fax:207-834-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125000000Medicaid
ME037354OtherBLUE CROSS BLUE SHEILD
ME1250000000Medicaid
MER0806OtherBLUE CROSS FEDERAL
000-610591OtherUNITED CONCORDIA