Provider Demographics
NPI:1477997534
Name:WRAY, KELLY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6007 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3615
Mailing Address - Country:US
Mailing Address - Phone:352-562-2251
Mailing Address - Fax:
Practice Address - Street 1:606 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4856
Practice Address - Country:US
Practice Address - Phone:410-744-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151731223X0400X
FLDN187781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics