Provider Demographics
NPI:1629283262
Name:RAYMOND KO D.D.S., INC.
Entity Type:Organization
Organization Name:RAYMOND KO D.D.S., INC.
Other - Org Name:FAMILY DENTAL TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-264-4543
Mailing Address - Street 1:1409 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3708
Mailing Address - Country:US
Mailing Address - Phone:559-264-4543
Mailing Address - Fax:559-264-0226
Practice Address - Street 1:1409 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3708
Practice Address - Country:US
Practice Address - Phone:559-264-4543
Practice Address - Fax:559-264-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37124122300000X
CA153211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty