Provider Demographics
NPI:1437591930
Name:BLAKE W. MCRAY, D.D.S., M.S.D., INC.
Entity Type:Organization
Organization Name:BLAKE W. MCRAY, D.D.S., M.S.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:707-642-3636
Mailing Address - Street 1:1309 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4645
Mailing Address - Country:US
Mailing Address - Phone:707-642-3636
Mailing Address - Fax:707-642-3637
Practice Address - Street 1:1309 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4645
Practice Address - Country:US
Practice Address - Phone:707-642-3636
Practice Address - Fax:707-642-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty