Provider Demographics
NPI:1790835650
Name:LAYNE, RAYMOND H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:H
Last Name:LAYNE
Suffix:JR
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:PO BOX 4007
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-4007
Mailing Address - Country:US
Mailing Address - Phone:850-674-5502
Mailing Address - Fax:850-674-9790
Practice Address - Street 1:19606 STATE ROAD 20 W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-3916
Practice Address - Country:US
Practice Address - Phone:850-674-5502
Practice Address - Fax:850-674-9790
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0068761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice