MEDICARE: DR. RAYMOND C HASTON JR. DDS

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	1223G0001X	General Practice Dentistry	05372	VA

General Provider Information

NPI Number	:	1104928894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND C HASTON JR. DDS

Provider Business Mailing Address
First Line	:	14393 HEREFORD RD
Second Line	:
City	:	DALE CITY
State	:	VA
Zip	:	22193-2107
Country	:	US
Telephone Number	:	703-670-8400
Fax Number	:	703-690-2050

Provider Business Practice Location Address
First Line	:	14393 HEREFORD RD
Second Line	:
City	:	DALE CITY
State	:	VA
Zip	:	22193-2107
Country	:	US
Telephone Number	:	703-670-8400
Fax Number	:	703-690-2050

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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