Organization
MARK RAYMOND DMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RAYMOND D.M.D (MANAGING MEMBER)
(276) 395-6632
Entity
Organization
Contact information
Practice address
208 FRONT ST., COEBURN, VA 24230
(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
ANTHEM BCBS
VA
05
—
9179077
—
VA
Enumeration date
02/05/2007
Last updated
08/22/2020
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