Provider Demographics
NPI:1134852452
Name:RAYMOND GIST DDS PC
Entity type:Organization
Organization Name:RAYMOND GIST DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:GIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-720-4170
Mailing Address - Street 1:4170 LENNON RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1083
Mailing Address - Country:US
Mailing Address - Phone:810-720-4170
Mailing Address - Fax:810-720-0426
Practice Address - Street 1:4170 LENNON RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1083
Practice Address - Country:US
Practice Address - Phone:810-720-4170
Practice Address - Fax:810-720-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty