Provider Demographics
NPI:1467905067
Name:FRANCO, RAUL O (DDS)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:O
Last Name:FRANCO
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 1:22D MEDICAL GROUP
Mailing Address - Street 2:57950 LEAVENWORTH ST
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-5181
Mailing Address - Fax:316-759-6277
Practice Address - Street 1:22D MEDICAL GROUP
Practice Address - Street 2:57950 LEAVENWORTH ST
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-5181
Practice Address - Fax:316-759-6277
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist