Provider Demographics
NPI:1295860385
Name:HAMBUCHEN, RAYMOND E (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:HAMBUCHEN
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 1:550 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5402
Mailing Address - Country:US
Mailing Address - Phone:501-329-8754
Mailing Address - Fax:501-329-2530
Practice Address - Street 1:550 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5402
Practice Address - Country:US
Practice Address - Phone:501-329-8754
Practice Address - Fax:501-329-2530
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice