Provider Demographics
NPI:1821079302
Name:RAI, SHAUN B (DMD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:B
Last Name:RAI
Suffix:
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 1:5720 GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6518
Mailing Address - Country:US
Mailing Address - Phone:757-499-6886
Mailing Address - Fax:757-499-3464
Practice Address - Street 1:5720 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6518
Practice Address - Country:US
Practice Address - Phone:757-499-6886
Practice Address - Fax:757-499-3464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-4102391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery