Individual
DR. RAYMOND LEO GENERAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
504 W PENN ST, SELINSGROVE, PA 17870-1644
(570) 374-4625
(570) 374-0052
Mailing address
PO BOX 265, SELINSGROVE, PA 17870-0265
(570) 374-4625
(570) 374-0052
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
031450-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031450-L
DENTAL LICENSE
PA
Enumeration date
12/13/2006
Last updated
03/07/2023
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