Provider Demographics
NPI:1669474094
Name:RAYBURN, RODNEY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:K
Last Name:RAYBURN
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 1:4910 WILLOWBEND BLVD
Mailing Address - Street 2:SUITE-C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3227
Mailing Address - Country:US
Mailing Address - Phone:713-729-1813
Mailing Address - Fax:713-729-6080
Practice Address - Street 1:4910 WILLOWBEND BLVD
Practice Address - Street 2:SUITE-C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3222
Practice Address - Country:US
Practice Address - Phone:713-729-1813
Practice Address - Fax:713-729-6080
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice