Healthcare Provider Details

I. General information

NPI: 1790703940
Provider Name (Legal Business Name): STEVEN K RAYES DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 PALMER COURT
NORWICH VT
05055
US

IV. Provider business mailing address

54 PALMER COURT
NORWICH VT
05055
US

V. Phone/Fax

Practice location:
  • Phone: 802-649-5210
  • Fax:
Mailing address:
  • Phone: 802-649-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1031
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04050
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1031
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: