Provider Demographics
NPI:1942365036
Name:RAYGAN, BOBBY LEE JR (DMD PC)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:LEE
Last Name:RAYGAN
Suffix:JR
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023
Mailing Address - Country:US
Mailing Address - Phone:205-491-4921
Mailing Address - Fax:205-491-4942
Practice Address - Street 1:115 FOREST ROAD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023
Practice Address - Country:US
Practice Address - Phone:205-491-4921
Practice Address - Fax:205-491-4942
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist