Provider Demographics
NPI:1134605116
Name:RAYNOR DENTAL PETERBOROUGH, PLLC
Entity type:Organization
Organization Name:RAYNOR DENTAL PETERBOROUGH, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-352-0006
Mailing Address - Street 1:650 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1758
Mailing Address - Country:US
Mailing Address - Phone:603-352-0006
Mailing Address - Fax:
Practice Address - Street 1:454 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1200
Practice Address - Country:US
Practice Address - Phone:603-924-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOONWOOD DENTAL PARTNERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-13
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790915957OtherNPI
1275659237OtherNPI
1306339593OtherNPI
1134605116OtherNPI
NH1255990255OtherNPI
1922294701OtherNPI