Provider Demographics
NPI:1639252323
Name:BLACKFORD, RAYMOND CLAUDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CLAUDE
Last Name:BLACKFORD
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 1:2900 RAUCH ROAD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182
Mailing Address - Country:US
Mailing Address - Phone:734-854-7923
Mailing Address - Fax:734-854-7813
Practice Address - Street 1:4210 SYLVANIA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-472-5006
Practice Address - Fax:419-472-0938
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300149211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice