Provider Demographics
NPI:1861095226
Name:MK RAYMOND DENTAL CORPORATION PC
Entity type:Organization
Organization Name:MK RAYMOND DENTAL CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-872-2170
Mailing Address - Street 1:3130 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-3443
Mailing Address - Country:US
Mailing Address - Phone:661-872-2170
Mailing Address - Fax:
Practice Address - Street 1:3130 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3443
Practice Address - Country:US
Practice Address - Phone:661-872-2170
Practice Address - Fax:818-773-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105526OtherCA DENTAL LICENSE