Provider Demographics
NPI:1568411247
Name:HYNSON, RAYMOND GRAHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:GRAHAM
Last Name:HYNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U S A DENTAC BLDG 2441
Mailing Address - Street 2:21ST STREET
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5369
Mailing Address - Country:US
Mailing Address - Phone:270-798-8614
Mailing Address - Fax:270-798-8614
Practice Address - Street 1:U S A DENTAC BLDG 2441
Practice Address - Street 2:21ST STREET
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5369
Practice Address - Country:US
Practice Address - Phone:270-798-8614
Practice Address - Fax:270-798-8614
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist