Provider Demographics
NPI:1093976490
Name:PRAY, MATTHEW ADAMS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAMS
Last Name:PRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218A E SHOCKLEY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-3739
Mailing Address - Country:US
Mailing Address - Phone:864-226-4411
Mailing Address - Fax:
Practice Address - Street 1:218A E SHOCKLEY FERRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-3739
Practice Address - Country:US
Practice Address - Phone:864-226-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice