MEDICARE: MRS. STEPHANIE NICOLE RAYMOND R.D.H.

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	124Q00000X	Dental Hygienist	12361	TX

General Provider Information

NPI Number	:	1255455671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE NICOLE RAYMOND R.D.H.

Provider Business Mailing Address
First Line	:	6413 TOWNSEND LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5226
Country	:	US
Telephone Number	:	214-404-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E STATE HWY 114
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262
Country	:	US
Telephone Number	:	817-567-8040
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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