Healthcare Provider Details

I. General information

NPI: 1669701272
Provider Name (Legal Business Name): RAYNOR DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COURT ST UNIT 4
KEENE NH
03431-1799
US

IV. Provider business mailing address

650 COURT ST UNIT 4
KEENE NH
03431-1799
US

V. Phone/Fax

Practice location:
  • Phone: 603-352-0006
  • Fax:
Mailing address:
  • Phone: 603-352-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3727
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON R RAYNOR
Title or Position: DENTIST
Credential: DMD
Phone: 603-352-0006