Provider Demographics
NPI:1770629636
Name:RAYMOND C. HASTON, D.D.S,
Entity type:Organization
Organization Name:RAYMOND C. HASTON, D.D.S,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:HASTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-286-1110
Mailing Address - Street 1:560 CELEBRATE VIRGINIA PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7298
Mailing Address - Country:US
Mailing Address - Phone:540-286-1110
Mailing Address - Fax:540-286-3783
Practice Address - Street 1:560 CELEBRATE VIRGINIA PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7298
Practice Address - Country:US
Practice Address - Phone:540-286-1110
Practice Address - Fax:540-286-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA53721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty