Provider Demographics
NPI:1114132289
Name:ANTONE, RAY CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:CLARK
Last Name:ANTONE
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 1:5975 FM 78
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1003
Mailing Address - Country:US
Mailing Address - Phone:210-661-4211
Mailing Address - Fax:210-661-3308
Practice Address - Street 1:5975 FM 78
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1003
Practice Address - Country:US
Practice Address - Phone:210-661-4211
Practice Address - Fax:210-661-3308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist