MEDICARE: DR. RAYMOND L. DORROUGH 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	1223G0001X	General Practice Dentistry	26752	CA

General Provider Information

NPI Number	:	1245360544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND L. DORROUGH D.D.S.

Provider Business Mailing Address
First Line	:	3105 RAILROAD AVE
Second Line	:	SUITE D
City	:	PITTSBURG
State	:	CA
Zip	:	94565-5252
Country	:	US
Telephone Number	:	925-432-8509
Fax Number	:	925-432-8357

Provider Business Practice Location Address
First Line	:	3105 RAILROAD AVE
Second Line	:	SUITE D
City	:	PITTSBURG
State	:	CA
Zip	:	94565-5252
Country	:	US
Telephone Number	:	925-432-8509
Fax Number	:	925-432-8357

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	01/05/2010

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