Provider Demographics
NPI:1780754143
Name:RAASS, DAVID LAWRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:RAASS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BONITA BEACH RD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134
Mailing Address - Country:US
Mailing Address - Phone:239-947-5858
Mailing Address - Fax:239-947-4511
Practice Address - Street 1:3635 BONITA BEACH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4157
Practice Address - Country:US
Practice Address - Phone:239-947-5858
Practice Address - Fax:239-947-4511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 8742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist