Provider Demographics
NPI:1285851220
Name:RAIDER, MARK E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RAIDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-6201
Mailing Address - Country:US
Mailing Address - Phone:845-628-3700
Mailing Address - Fax:845-628-3010
Practice Address - Street 1:888 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-6201
Practice Address - Country:US
Practice Address - Phone:845-628-3700
Practice Address - Fax:845-628-3010
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0529611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice