Provider Demographics
NPI:1912902214
Name:RAIMONDO, RICHARD LOUIS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:RAIMONDO
Suffix:JR
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 1:12521 NACOGDOCHES RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2117
Mailing Address - Country:US
Mailing Address - Phone:210-653-3452
Mailing Address - Fax:
Practice Address - Street 1:12521 NACOGDOCHES RD
Practice Address - Street 2:STE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2117
Practice Address - Country:US
Practice Address - Phone:210-653-3452
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice