Provider Demographics
NPI:1083893135
Name:LANOUE, RAYMOND KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:KENNETH
Last Name:LANOUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 E GREENWAY PKWY APT 2039
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2138
Mailing Address - Country:US
Mailing Address - Phone:602-741-7108
Mailing Address - Fax:
Practice Address - Street 1:6735 E GREENWAY PKWY APT 2039
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2138
Practice Address - Country:US
Practice Address - Phone:602-741-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist