Healthcare Provider Details

I. General information

NPI: 1730606781
Provider Name (Legal Business Name): RAYMOND DUONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARK AVE
MANHASSET NY
11030-2442
US

IV. Provider business mailing address

560 79TH ST
BROOKLYN NY
11209-3710
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-7575
  • Fax:
Mailing address:
  • Phone: 917-337-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS107353
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02999800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number060559
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: