Provider Demographics
NPI:1376754507
Name:RAYMOND AU & AUGUSTINE AU DDS PC
Entity Type:Organization
Organization Name:RAYMOND AU & AUGUSTINE AU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:CHI-KUEN
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-923-1304
Mailing Address - Street 1:121 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2402
Mailing Address - Country:US
Mailing Address - Phone:215-923-1304
Mailing Address - Fax:215-923-5730
Practice Address - Street 1:121 N 10TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2402
Practice Address - Country:US
Practice Address - Phone:215-923-1304
Practice Address - Fax:215-923-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 021021 L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty