Provider Demographics
NPI:1689606014
Name:RAYMOND, LOREN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5718
Mailing Address - Country:US
Mailing Address - Phone:330-825-4549
Mailing Address - Fax:330-825-7360
Practice Address - Street 1:4322 CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5718
Practice Address - Country:US
Practice Address - Phone:330-825-4549
Practice Address - Fax:330-825-7360
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300133451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103677Medicaid