Provider Demographics
NPI:1326326281
Name:NEPOMUCENO, RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:NEPOMUCENO
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 1:2020 COFFEE RD
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2427
Mailing Address - Country:US
Mailing Address - Phone:209-529-5886
Mailing Address - Fax:
Practice Address - Street 1:2020 COFFEE RD
Practice Address - Street 2:SUITE B-4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2427
Practice Address - Country:US
Practice Address - Phone:209-529-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist