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General NPI Number Information
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NPI Number | 1083782064
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Entity Type | Individual
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Provider Name | CHRISTINE RAYBURN DMD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 2608 S LAMAR BLVD STE 101
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City | OXFORD
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State | MS
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Zip | 38655-5243
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Country | US
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Telephone | 662-281-8455
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Fax | 154-618-2538
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Provider Business Mailing Address
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Address Line | 403 NORTH THIRD STREET
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City | BOONEVILLE
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State | MS
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Zip | 38829
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Country | US
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Telephone | 662-728-8171
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Fax | 662-728-1093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3241-02
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License Number State | MS
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