| Mark Raymond Dmd Pllc | |
|
208 Front St. Coeburn VA 24230 | |
| (276) 395-6632 | |
| (276) 395-5601 |
| Full Name | Mark Raymond Dmd Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 208 Front St., Coeburn, Virginia |
| Authorized Official Name and Position | Mark Raymond (MANAGING MEMBER) |
| Authorized Official Contact | 2763956632 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Raymond Dmd Pllc Po Box 2214 Coeburn VA 24230-2214 Ph: (276) 395-6632 | Mark Raymond Dmd Pllc 208 Front St. Coeburn VA 24230 Ph: (276) 395-6632 |
| NPI Number | 1518006766 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518006766 | NPI | - | NPPES |
| 9179077 | Medicaid | VA | |
| 146346 | Other | VA | ANTHEM BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0401410712 (Virginia) | Primary |