Provider Demographics
NPI:1023219367
Name:ROBERT G. RAY D.M.D
Entity Type:Organization
Organization Name:ROBERT G. RAY D.M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-494-4344
Mailing Address - Street 1:8600 LASALLE RD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2001
Mailing Address - Country:US
Mailing Address - Phone:410-494-4344
Mailing Address - Fax:
Practice Address - Street 1:8600 LASALLE RD
Practice Address - Street 2:SUITE 630
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2001
Practice Address - Country:US
Practice Address - Phone:410-494-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT G. RAY D.M.D PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD65161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty