MEDICARE: DR. RAYMOND HALAIS D.M.D.

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	1223E0200X	Endodontics	1893	PR
2	1223E0200X	Endodontics	17849	MA
3	1223E0200X	Endodontics	DN013797	GA

General Provider Information

NPI Number	:	1710984786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND HALAIS D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7706
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-7706
Country	:	US
Telephone Number	:	787-745-3636
Fax Number	:	787-286-3636

Provider Business Practice Location Address
First Line	:	201 CALLE GAUTIER BENITEZ
Second Line	:	STE 200
City	:	CAGUAS
State	:	PR
Zip	:	00725-5527
Country	:	US
Telephone Number	:	787-745-3636
Fax Number	:	787-286-3636

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/09/2010

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