Provider Demographics
NPI:1275974156
Name:RAY, SHEETAL (DMD)
Entity Type:Individual
Prefix:
First Name:SHEETAL
Middle Name:
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 1:1221 S EADS ST
Mailing Address - Street 2:APT 311
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4729
Mailing Address - Country:US
Mailing Address - Phone:858-774-2808
Mailing Address - Fax:
Practice Address - Street 1:4379 RIDGEWOOD CENTER DR
Practice Address - Street 2:STE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8322
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist