Provider Demographics
NPI:1598803256
Name:PRICE, RAYMOND LEROY (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LEROY
Last Name:PRICE
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0455
Mailing Address - Country:US
Mailing Address - Phone:715-684-3264
Mailing Address - Fax:
Practice Address - Street 1:1730 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-0455
Practice Address - Country:US
Practice Address - Phone:715-684-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI685G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice