Provider Demographics
NPI:1285653709
Name:BOLDUC, RAYMOND N (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:N
Last Name:BOLDUC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:7 RAYMOND RD
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-0425
Mailing Address - Country:US
Mailing Address - Phone:603-483-8123
Mailing Address - Fax:603-483-8127
Practice Address - Street 1:7 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NH
Practice Address - Zip Code:03032-0425
Practice Address - Country:US
Practice Address - Phone:603-483-8123
Practice Address - Fax:603-483-8127
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81192076Medicaid
NH30306440Medicaid