Provider Demographics
NPI:1780611921
Name:RAFFENSPERGER, D. WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:D.
Middle Name:WILLIAM
Last Name:RAFFENSPERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:WILLIAM
Other - Last Name:RAFFENSPERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:1026 MAIN ST.
Mailing Address - City:BLUE BALL
Mailing Address - State:PA
Mailing Address - Zip Code:17506-0175
Mailing Address - Country:US
Mailing Address - Phone:717-354-2372
Mailing Address - Fax:
Practice Address - Street 1:1026 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BLUE BALL
Practice Address - State:PA
Practice Address - Zip Code:17506-0175
Practice Address - Country:US
Practice Address - Phone:717-354-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021554L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103312OtherUNITED CONCORDIA