Provider Demographics
NPI:1124135884
Name:RABER, MYRIAM E H (DDS)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:E H
Last Name:RABER
Suffix:
Gender:F
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:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:KIDRON
Mailing Address - State:OH
Mailing Address - Zip Code:44636-0020
Mailing Address - Country:US
Mailing Address - Phone:330-857-0144
Mailing Address - Fax:330-857-0246
Practice Address - Street 1:3693 KIDRON RD
Practice Address - Street 2:
Practice Address - City:KIDRON
Practice Address - State:OH
Practice Address - Zip Code:44636-0020
Practice Address - Country:US
Practice Address - Phone:330-857-0144
Practice Address - Fax:330-857-0246
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300214621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30021462OtherSTATE LICENSE NUMBER