Basic Information
| Provider Information | |||||||||
| NPI: | 1710017736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAUGUST | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1954 | ||||||||
| Address2: | |||||||||
| City: | BUCKLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983211954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608299099 | ||||||||
| FaxNumber: | 3608299199 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 RYAN RD | ||||||||
| Address2: | |||||||||
| City: | BUCKLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983219115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608293077 | ||||||||
| FaxNumber: | 3608293088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 4664 | WA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 4664 | 01 | WA | DENTAL LICENCE | OTHER |