Provider Demographics
NPI:1093827503
Name:PANET-RAYMOND, MARC ANDRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDRE
Last Name:PANET-RAYMOND
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 1:150 MADRONA AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4608
Mailing Address - Country:US
Mailing Address - Phone:503-362-3719
Mailing Address - Fax:503-362-7199
Practice Address - Street 1:150 MADRONA AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4608
Practice Address - Country:US
Practice Address - Phone:503-362-3719
Practice Address - Fax:503-362-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice