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General NPI Number Information
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NPI Number | 1669430443
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Entity Type | Individual
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Provider Name | GERALD E RAYBECK DDS, MBA, MAGD
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 901 RANCHO LN
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City | LAS VEGAS
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State | NV
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Zip | 89106-3836
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Country | US
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Telephone | 702-636-3060
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Fax | 702-636-3057
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Provider Business Mailing Address
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Address Line | 901 RANCHO LN
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City | LAS VEGAS
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State | NV
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Zip | 89106-3836
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Country | US
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Telephone | 702-636-3060
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Fax | 702-636-3057
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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 | 4173
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS023860L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | M858
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License Number State | SD
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