Provider Demographics
NPI:1164499380
Name:IRVING-RAY, MARCIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:IRVING-RAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2701
Mailing Address - Country:US
Mailing Address - Phone:513-221-4949
Mailing Address - Fax:
Practice Address - Street 1:2805 GILBERT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1210
Practice Address - Country:US
Practice Address - Phone:513-281-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2597033Medicaid