Provider Demographics
NPI:1073693222
Name:RAY, SHAWN R (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 32ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4072
Mailing Address - Country:US
Mailing Address - Phone:319-294-2323
Mailing Address - Fax:319-395-6715
Practice Address - Street 1:1615 32ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4072
Practice Address - Country:US
Practice Address - Phone:319-294-2323
Practice Address - Fax:319-395-6715
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18544OtherBLUE CROSS BLUE SHIELD