Provider Demographics
NPI:1730385626
Name:TSENG, RAYMOND J (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:TSENG
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 WELLESLEY TRADE LN
Mailing Address - Street 2:212
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5669
Mailing Address - Country:US
Mailing Address - Phone:919-267-4211
Mailing Address - Fax:888-343-9351
Practice Address - Street 1:351 WELLESLEY TRADE LN
Practice Address - Street 2:212
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5669
Practice Address - Country:US
Practice Address - Phone:919-267-4211
Practice Address - Fax:888-343-9351
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8837122300000X
MIM290725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915868Medicaid