Provider Demographics
NPI:1225761950
Name:RAY, KATELYNN ALISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATELYNN
Middle Name:ALISE
Last Name:RAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOCKHART DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1592
Mailing Address - Country:US
Mailing Address - Phone:252-504-2138
Mailing Address - Fax:
Practice Address - Street 1:200 LOCKHART DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1592
Practice Address - Country:US
Practice Address - Phone:252-504-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice