Provider Demographics
NPI:1124759667
Name:KLEEFISCH, RAYMOND CARL III (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CARL
Last Name:KLEEFISCH
Suffix:III
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 1:10504 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2064
Mailing Address - Country:US
Mailing Address - Phone:504-453-1725
Mailing Address - Fax:
Practice Address - Street 1:1562 MITSCHER AVE STE 250
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-2197
Practice Address - Country:US
Practice Address - Phone:757-953-8593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist