Provider Demographics
NPI:1073589479
Name:GANT, RAYMOND CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:GANT
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 1:6900 GEORGIA AVE, NW
Mailing Address - Street 2:BUILDING T20, ROOM 206B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-5400
Mailing Address - Country:US
Mailing Address - Phone:202-782-0988
Mailing Address - Fax:202-782-9195
Practice Address - Street 1:9515 HALL ROAD
Practice Address - Street 2:BUILDING 1099
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-806-4393
Practice Address - Fax:703-806-4376
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC734005070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist