Provider Demographics
NPI:1710101829
Name:RAYMOND, ROBERT L (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:RAYMOND
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 1:1915 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2614
Mailing Address - Country:US
Mailing Address - Phone:215-668-1230
Mailing Address - Fax:
Practice Address - Street 1:125 E SWEDESFORD RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1463
Practice Address - Country:US
Practice Address - Phone:610-687-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030487L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry