MEDICARE: RAYMOND S VICENTE DMD LLC

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	122300000X	Dentist	SC3976	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831371913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMOND S VICENTE DMD LLC

Provider Business Mailing Address
First Line	:	7481 NORTHSIDE DRIVE
Second Line	:	SUITE A
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4282
Country	:	US
Telephone Number	:	843-863-8634
Fax Number	:	843-863-8242

Provider Business Practice Location Address
First Line	:	7481 NORTHSIDE DRIVE
Second Line	:	SUITE A
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4282
Country	:	US
Telephone Number	:	843-863-8634
Fax Number	:	843-863-8242

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. RAYMOND S VICENTE
Credential	:	DMD
Telephone Number	:	843-863-8634

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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