Individual
MARK ANTHONY RAYMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
208 FRONT ST W, COEBURN, VA 24230-3502
(276) 395-6632
(276) 395-5601
Mailing address
PO BOX 2214, COEBURN, VA 24230-2214
(276) 395-6632
(276) 395-5601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410712
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146346
BLUE CROSS BLUE SHIELD
VA
05
—
9179077
—
VA
Enumeration date
12/22/2005
Last updated
07/08/2007
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