Provider Demographics
NPI:1851758387
Name:CHAO, RAYLIEN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RAYLIEN
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DUNLIN DUNES PL APT 308
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-0845
Mailing Address - Country:US
Mailing Address - Phone:608-772-2780
Mailing Address - Fax:
Practice Address - Street 1:2450 DUNLIN DUNES PL APT 308
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-0845
Practice Address - Country:US
Practice Address - Phone:608-772-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist