Provider Demographics
NPI:1942540943
Name:RAYGADA & RABANAL DDS INC.
Entity Type:Organization
Organization Name:RAYGADA & RABANAL DDS INC.
Other - Org Name:PALM DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYGADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-948-8953
Mailing Address - Street 1:7733 PALM ST STE 107
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2967
Mailing Address - Country:US
Mailing Address - Phone:619-460-1991
Mailing Address - Fax:
Practice Address - Street 1:7733 PALM ST STE 107
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2967
Practice Address - Country:US
Practice Address - Phone:619-460-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty