Provider Demographics
NPI:1083635817
Name:RAYNOR-CANO
Entity Type:Organization
Organization Name:RAYNOR-CANO
Other - Org Name:STORRS FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-429-6406
Mailing Address - Street 1:1022 STORRS RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2639
Mailing Address - Country:US
Mailing Address - Phone:860-429-6406
Mailing Address - Fax:
Practice Address - Street 1:1022 STORRS RD
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-2639
Practice Address - Country:US
Practice Address - Phone:860-429-6406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT092701223G0001X
CT61411223G0001X
CT46471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty