Provider Demographics
NPI:1609085117
Name:DOREMUS, RAYMOND J
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:DOREMUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 LINTON BLVD
Mailing Address - Street 2:# 11
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6688
Mailing Address - Country:US
Mailing Address - Phone:561-495-7277
Mailing Address - Fax:
Practice Address - Street 1:4900 LINTON BLVD
Practice Address - Street 2:# 11
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6688
Practice Address - Country:US
Practice Address - Phone:561-495-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 86861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice