Provider Demographics
NPI:1619859568
Name:DOMINIC J. RAYMOND II, DDS, PLLC
Entity type:Organization
Organization Name:DOMINIC J. RAYMOND II, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-391-4086
Mailing Address - Street 1:1554 MILEGROUND RD STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3711
Mailing Address - Country:US
Mailing Address - Phone:304-296-2273
Mailing Address - Fax:
Practice Address - Street 1:1554 MILEGROUND RD STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3711
Practice Address - Country:US
Practice Address - Phone:304-296-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty