Provider Demographics
NPI:1609918705
Name:TASH, RAYMOND M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:TASH
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 1:6438 RITA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4187
Mailing Address - Country:US
Mailing Address - Phone:323-277-4044
Mailing Address - Fax:323-277-4047
Practice Address - Street 1:6438 RITA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4187
Practice Address - Country:US
Practice Address - Phone:323-277-4044
Practice Address - Fax:323-277-4047
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist