Provider Demographics
NPI:1003360769
Name:RAY, INELL DENISE (000)
Entity Type:Individual
Prefix:MS
First Name:INELL
Middle Name:DENISE
Last Name:RAY
Suffix:
Gender:F
Credentials:000
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CREEK ST APT B
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2450
Mailing Address - Country:US
Mailing Address - Phone:254-466-4925
Mailing Address - Fax:
Practice Address - Street 1:415 CREEK ST APT B
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2450
Practice Address - Country:US
Practice Address - Phone:254-466-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant