Individual
SHELLY SUZANNE RAICHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
0057 EDWARDS ACCESS RD, SUITE 21, EDWARDS, CO 81632
(970) 926-1519
(970) 926-1044
Mailing address
PO BOX 1478, EDWARDS, CO 81632-1478
(970) 926-1519
(970) 926-1044
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7209
CO
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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