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NPI Code Detail

MEDICARE: SHAUN B RAI D.M.D.

MEDICARE: SHAUN B RAI 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
11223S0112XOral and Maxillofacial Surgery (Dentist)0401-410239VA

General Provider Information

NPI Number : 1821079302
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUN B RAI D.M.D.
Provider Business Mailing Address
First Line : 5720 GREENWICH RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-6518
Country : US
Telephone Number : 757-499-6886
Fax Number : 757-499-3464
Provider Business Practice Location Address
First Line : 5720 GREENWICH RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-6518
Country : US
Telephone Number : 757-499-6886
Fax Number : 757-499-3464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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