Provider Demographics
NPI:1043959885
Name:RAY FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:RAY FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-816-1874
Mailing Address - Street 1:2012 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9456
Mailing Address - Country:US
Mailing Address - Phone:304-368-0342
Mailing Address - Fax:
Practice Address - Street 1:2012 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9456
Practice Address - Country:US
Practice Address - Phone:304-368-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental