Provider Demographics
NPI:1114087103
Name:RACZ, PATRICK JOSEPH
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:RACZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-3003
Mailing Address - Country:US
Mailing Address - Phone:603-236-6233
Mailing Address - Fax:
Practice Address - Street 1:17 LEVESQUE DR
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1948
Practice Address - Country:US
Practice Address - Phone:207-439-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice