Healthcare Provider Details

I. General information

NPI: 1710017736
Provider Name (Legal Business Name): JAMES THOMAS RAUGUST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 RYAN RD
BUCKLEY WA
98321-9115
US

IV. Provider business mailing address

PO BOX 1954
BUCKLEY WA
98321-1954
US

V. Phone/Fax

Practice location:
  • Phone: 360-829-3077
  • Fax: 360-829-3088
Mailing address:
  • Phone: 360-829-9099
  • Fax: 360-829-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4664
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: