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General NPI Number Information
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NPI Number | 1639341225
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Entity Type | Organization
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Legal Business Name | RAYMOND A. JOKUBAITIS, D.M.D., P.A.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 126 W CHARLOTTE AVE
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City | MOUNT HOLLY
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State | NC
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Zip | 28120-1776
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Country | US
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Telephone | 704-827-8446
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Fax | 704-822-1069
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Provider Business Mailing Address
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Address Line | 126 W CHARLOTTE AVE
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City | MOUNT HOLLY
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State | NC
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Zip | 28120-1776
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Country | US
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Telephone | 704-827-8446
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Fax | 704-822-1069
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND A. JOKUBAITIS
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Credential | D.M.D.
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Telephone | 704-827-8446
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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 | 5816
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License Number State | NC
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