MEDICARE: DR. RAYMOND LEE MEADE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401003990	VA

General Provider Information

NPI Number	:	1083659023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND LEE MEADE D.D.S.

Provider Business Mailing Address
First Line	:	2018 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2310
Country	:	US
Telephone Number	:	804-520-1741
Fax Number	:	804-520-4750

Provider Business Practice Location Address
First Line	:	2018 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2310
Country	:	US
Telephone Number	:	804-520-1741
Fax Number	:	804-520-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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