Provider Demographics
NPI:1194996231
Name:RAGLAND PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:RAGLAND PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-972-9133
Mailing Address - Street 1:1820 AVONDALE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1394
Mailing Address - Country:US
Mailing Address - Phone:916-972-9133
Mailing Address - Fax:916-367-6725
Practice Address - Street 1:1820 AVONDALE AVE STE 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1394
Practice Address - Country:US
Practice Address - Phone:916-972-9133
Practice Address - Fax:916-367-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty