Healthcare Provider Details

I. General information

NPI: 1003753948
Provider Name (Legal Business Name): RAGHID KRAYEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 COSBY VILLAGE RD
CHESTERFIELD VA
23832-1939
US

IV. Provider business mailing address

11513 PINEDALE DR
GLEN ALLEN VA
23059-5586
US

V. Phone/Fax

Practice location:
  • Phone: 804-570-1143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420012
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: