Provider Demographics
NPI:1083641120
Name:CHRISTINE, RAYMOND L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:CHRISTINE
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 1:604 E BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2286
Mailing Address - Country:US
Mailing Address - Phone:765-864-2325
Mailing Address - Fax:765-453-6920
Practice Address - Street 1:604 E BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-8801
Practice Address - Country:US
Practice Address - Phone:765-459-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120082521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice