Provider Demographics
NPI:1003087784
Name:JERROLD N RAAB DDS PC
Entity type:Organization
Organization Name:JERROLD N RAAB DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-528-6520
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:RTE 23
Mailing Address - City:MONTERRY
Mailing Address - State:MA
Mailing Address - Zip Code:01245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:549 RTE 23
Practice Address - Street 2:
Practice Address - City:MONTERRY
Practice Address - State:MA
Practice Address - Zip Code:01245
Practice Address - Country:US
Practice Address - Phone:413-528-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty