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NPI Code Detail

MEDICARE: RAYGAN NEELY FLUITT R.D.H.

MEDICARE:   RAYGAN NEELY FLUITT  R.D.H.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist3089LA

General Provider Information

NPI Number : 1396831632
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYGAN NEELY FLUITT R.D.H.
Provider Business Mailing Address
First Line : 170 RABBIT RUN LN
Second Line :
City : MANY
State : LA
Zip : 71449-7127
Country : US
Telephone Number : 318-256-9319
Fax Number :
Provider Business Practice Location Address
First Line : 695 SAN ANTONIO AVE
Second Line :
City : MANY
State : LA
Zip : 71449-3018
Country : US
Telephone Number : 318-256-3641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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Directions to “ RAYGAN NEELY FLUITT R.D.H.” Practice Location

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