Provider Demographics
NPI:1881435485
Name:RAIA, STEPHEN MARIO (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARIO
Last Name:RAIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FARMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2922
Mailing Address - Country:US
Mailing Address - Phone:360-609-6059
Mailing Address - Fax:
Practice Address - Street 1:20936 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7353
Practice Address - Country:US
Practice Address - Phone:434-237-0004
Practice Address - Fax:434-237-6597
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice