Provider Demographics
NPI:1114208667
Name:BRAY, STEPHEN JAMES
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:BRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:JAMES
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:151 TREMONT ST
Mailing Address - Street 2:APT 22 B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1125
Mailing Address - Country:US
Mailing Address - Phone:617-202-5098
Mailing Address - Fax:
Practice Address - Street 1:1,KNEELAND STREET
Practice Address - Street 2:TUFTS SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6817
Practice Address - Fax:617-636-3831
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF10675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist