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General NPI Number Information
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NPI Number | 1881435485
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Entity Type | Individual
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Provider Name | STEPHEN MARIO RAIA DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 20936 TIMBERLAKE RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-7353
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Country | US
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Telephone | 434-237-0004
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Fax | 434-237-6597
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Provider Business Mailing Address
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Address Line | 2712 FARMINGTON PL
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City | LYNCHBURG
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State | VA
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Zip | 24503-2922
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Country | US
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Telephone | 360-609-6059
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401418992
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License Number State | VA
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