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General NPI Number Information
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NPI Number | 1285851220
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Entity Type | Individual
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Provider Name | MARK E RAIDER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 888 ROUTE 6
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City | MAHOPAC
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State | NY
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Zip | 10541-6201
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Country | US
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Telephone | 845-628-3700
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Fax | 845-628-3010
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Provider Business Mailing Address
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Address Line | 888 ROUTE 6
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City | MAHOPAC
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State | NY
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Zip | 10541-6201
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Country | US
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Telephone | 845-628-3700
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Fax | 845-628-3010
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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 | 50 052961
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License Number State | NY
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