Individual
RAYMOND WIDICAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-2255
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9962
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH152
HARVARD PILGRIM
MA
01
—
X03621
BCBS - DENTAL
MA
Enumeration date
03/16/2006
Last updated
04/08/2009
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