Raynald L. Desameau DMD PLLC III

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

RAYNALD L. DESAMEAU DMD PLLC III

Doing business as

Coral Reef Pediatric Dentistry

Practice address

10460 Park Road
Charlotte, NC 28210

Phone

(704) 540-5440

NPI assigned

Oct 25, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raynald Leon Desameau, DMD

Title

Owner/Member

Phone

(912) 332-3932

Specialties & licenses 1

Addresses

Other names 1

• Coral Reef Pediatric Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1396567095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10460 PARK ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10460 PARK ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28210",
            "telephone_number": "704-540-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYNALD L. DESAMEAU DMD PLLC III",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "DESAMEAU",
        "authorized_official_first_name": "RAYNALD",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "912-332-3932",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coral Reef Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lawrence Raymond
• Maegan Marissa Raymond, PA-C
• Michelle Lynn Raymond, OTR/L
• Sandra Hope Raymore, MD
• Raynald L. Desameau DMD PLLC
• Raynald L. Desameau DMD PLLC IV
• Julie Sweet Rayner, CRNA
• Savannah Katherine Raynor, LMFT
• Amy Beth Raz, M.D.
• Sammy Razik, M.D

• Pediatric Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.