Healthcare Provider Details

I. General information

NPI: 1780740977
Provider Name (Legal Business Name): RAYMOND T BEDETTE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLOW RUN
AUBURN ME
04210-8501
US

IV. Provider business mailing address

1 WILLOW RUN
AUBURN ME
04210-8501
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-8587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2797
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: