Provider Demographics
NPI:1538160361
Name:NASSIMBENE, RAYMOND RICHARD I
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:RICHARD
Last Name:NASSIMBENE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 E VASSAR AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6115
Mailing Address - Country:US
Mailing Address - Phone:303-782-0340
Mailing Address - Fax:303-782-0340
Practice Address - Street 1:800 ENGLEWOOD PKWY
Practice Address - Street 2:SUITE A-201
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-7315
Practice Address - Country:US
Practice Address - Phone:303-744-5000
Practice Address - Fax:303-744-5600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice