Provider Demographics
NPI:1326236035
Name:RAY, JOEL A (RDH)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:RAY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4447
Mailing Address - Country:US
Mailing Address - Phone:707-442-1754
Mailing Address - Fax:707-442-1755
Practice Address - Street 1:615 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4447
Practice Address - Country:US
Practice Address - Phone:707-442-1754
Practice Address - Fax:707-442-1755
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23252OtherSTATE OF CALIFORNIA