Provider Demographics
NPI:1093713224
Name:DAMERAL, RAY DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:DOUGLAS
Last Name:DAMERAL
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 1:1150 WESTWOOD DR
Mailing Address - Street 2:STE F
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-5317
Mailing Address - Country:US
Mailing Address - Phone:406-375-9218
Mailing Address - Fax:406-375-9015
Practice Address - Street 1:1150 WESTWOOD DR
Practice Address - Street 2:STE F
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-5317
Practice Address - Country:US
Practice Address - Phone:406-375-9218
Practice Address - Fax:406-375-9015
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1948122300000X
CA18459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist