Provider Demographics
NPI:1669701272
Name:RAYNOR DENTAL PLLC
Entity type:Organization
Organization Name:RAYNOR DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-352-0006
Mailing Address - Street 1:650 COURT ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1799
Mailing Address - Country:US
Mailing Address - Phone:603-352-0006
Mailing Address - Fax:
Practice Address - Street 1:650 COURT ST
Practice Address - Street 2:UNIT 4
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1799
Practice Address - Country:US
Practice Address - Phone:603-352-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
NH37271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184119075OtherNPI