Provider Demographics
NPI:1902030638
Name:RAYMOND T. BEDETTE, DDS, PA
Entity Type:Organization
Organization Name:RAYMOND T. BEDETTE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-784-8587
Mailing Address - Street 1:1 WILLOW RUN
Mailing Address - Street 2:1-A
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8501
Mailing Address - Country:US
Mailing Address - Phone:207-784-8587
Mailing Address - Fax:207-777-5251
Practice Address - Street 1:1 WILLOW RUN
Practice Address - Street 2:1-A
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8501
Practice Address - Country:US
Practice Address - Phone:207-784-8587
Practice Address - Fax:207-777-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112820000Medicaid