Provider Demographics
NPI:1548379563
Name:FOURNIER, RAYMOND B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:B
Last Name:FOURNIER
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 1:1701 FAIRWAY DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4661
Mailing Address - Country:US
Mailing Address - Phone:281-331-0020
Mailing Address - Fax:281-585-0505
Practice Address - Street 1:1701 FAIRWAY DR
Practice Address - Street 2:SUITE 20
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4661
Practice Address - Country:US
Practice Address - Phone:281-331-0020
Practice Address - Fax:281-585-0505
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice