Healthcare Provider Details

I. General information

NPI: 1649568528
Provider Name (Legal Business Name): RICHARD RAYMOND D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 PEACHTREE RD NE STE 200
ATLANTA GA
30309-1182
US

IV. Provider business mailing address

2233 PEACHTREE RD NE STE 200
ATLANTA GA
30309-1182
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-8503
  • Fax:
Mailing address:
  • Phone: 404-500-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN014230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: