Provider Demographics
NPI:1215950746
Name:RAYMOND, LOYLE D (DDS)
Entity type:Individual
Prefix:DR
First Name:LOYLE
Middle Name:D
Last Name:RAYMOND
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 1:7575 GOLDEN VALLEY ROAD
Mailing Address - Street 2:STE 240
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4571
Mailing Address - Country:US
Mailing Address - Phone:763-525-0306
Mailing Address - Fax:763-525-0885
Practice Address - Street 1:7575 GOLDEN VALLEY ROAD
Practice Address - Street 2:STE 240
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4571
Practice Address - Country:US
Practice Address - Phone:763-525-0306
Practice Address - Fax:763-525-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND84791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice