Provider Demographics
NPI:1437720190
Name:RAY, PHILLIP MARTIN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARTIN
Last Name:RAY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 GLENRAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8279
Mailing Address - Country:US
Mailing Address - Phone:678-995-2281
Mailing Address - Fax:
Practice Address - Street 1:3603 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5803
Practice Address - Country:US
Practice Address - Phone:270-798-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist