Provider Demographics
NPI:1396831632
Name:FLUITT, RAYGAN NEELY (RDH)
Entity Type:Individual
Prefix:
First Name:RAYGAN
Middle Name:NEELY
Last Name:FLUITT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 RABBIT RUN LN
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-7127
Mailing Address - Country:US
Mailing Address - Phone:318-256-9319
Mailing Address - Fax:
Practice Address - Street 1:695 SAN ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3018
Practice Address - Country:US
Practice Address - Phone:318-256-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3089124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist