Healthcare Provider Details

I. General information

NPI: 1972104032
Provider Name (Legal Business Name): RAYNHAM DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 ORCHARD ST
RAYNHAM MA
02767-1342
US

IV. Provider business mailing address

688 ORCHARD ST
RAYNHAM MA
02767-1342
US

V. Phone/Fax

Practice location:
  • Phone: 781-562-3442
  • Fax:
Mailing address:
  • Phone: 781-562-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD T MILLER
Title or Position: OWNER
Credential: DMD
Phone: 781-562-3442