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General NPI Number Information
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NPI Number | 1851614499
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Entity Type | Individual
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Provider Name | MARKOS RAPTIS DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 401 CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-3924
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Country | US
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Telephone | 617-953-3780
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-3924
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Country | US
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Telephone | 617-953-3780
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 010211
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License Number State | CT
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