Provider Demographics
NPI:1184219909
Name:MK RAYMOND DENTAL CORPORATION PC
Entity Type:Organization
Organization Name:MK RAYMOND DENTAL CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-426-2885
Mailing Address - Street 1:20523 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3208
Mailing Address - Country:US
Mailing Address - Phone:818-773-0911
Mailing Address - Fax:818-773-9720
Practice Address - Street 1:20523 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3208
Practice Address - Country:US
Practice Address - Phone:818-773-0911
Practice Address - Fax:818-773-9720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MK RAYMOND DENTAL CORPORATION PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105526OtherDENTAL BOARD OF CALIFORNIA