Provider Demographics
NPI:1104644830
Name:BOBBY L. RAYGAN JR. DMD PC
Entity type:Organization
Organization Name:BOBBY L. RAYGAN JR. DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAYGAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-491-4921
Mailing Address - Street 1:115 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2410
Mailing Address - Country:US
Mailing Address - Phone:205-491-4921
Mailing Address - Fax:205-491-4942
Practice Address - Street 1:115 FOREST RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2410
Practice Address - Country:US
Practice Address - Phone:205-491-4921
Practice Address - Fax:205-491-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty