Provider Demographics
NPI:1083692461
Name:MAIWURM, RAY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:A
Last Name:MAIWURM
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 1:4362 NORTHLAKE BLVD
Mailing Address - Street 2:STE 114
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6275
Mailing Address - Country:US
Mailing Address - Phone:561-626-3424
Mailing Address - Fax:561-626-5909
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:STE 114
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-626-3424
Practice Address - Fax:561-626-5909
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN62201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice