Provider Demographics
NPI:1710909072
Name:GEORGE, RAYMOND JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:GEORGE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:869 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3724
Mailing Address - Country:US
Mailing Address - Phone:401-434-1127
Mailing Address - Fax:401-431-1466
Practice Address - Street 1:288 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6846
Practice Address - Country:US
Practice Address - Phone:508-761-5230
Practice Address - Fax:508-761-8310
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165141223X0400X
RI22201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics