Provider Demographics
NPI:1376657478
Name:RAAB, JERROLD NATHAN
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:NATHAN
Last Name:RAAB
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:PO BOX 522
Mailing Address - Street 2:RTE 23
Mailing Address - City:MONTEREY
Mailing Address - State:MA
Mailing Address - Zip Code:01245-0522
Mailing Address - Country:US
Mailing Address - Phone:413-528-6520
Mailing Address - Fax:413-528-6520
Practice Address - Street 1:549 RTE 23
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:MA
Practice Address - Zip Code:01245-0522
Practice Address - Country:US
Practice Address - Phone:413-528-6520
Practice Address - Fax:413-528-6520
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics