Provider Demographics
NPI:1902926546
Name:JOHN, RAYMOND HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HOWARD
Last Name:JOHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 FORSYTHE AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3608
Mailing Address - Country:US
Mailing Address - Phone:318-322-1043
Mailing Address - Fax:318-322-4466
Practice Address - Street 1:2001 FORSYTHE AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3608
Practice Address - Country:US
Practice Address - Phone:318-322-1043
Practice Address - Fax:318-322-4466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice