Provider Demographics
NPI:1558719245
Name:TATE, RAY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:DEAN
Last Name:TATE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:DEAN
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:705 EAGLE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036
Mailing Address - Country:US
Mailing Address - Phone:405-262-6677
Mailing Address - Fax:405-262-1235
Practice Address - Street 1:705 EAGLE CIRCLE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:405-262-6677
Practice Address - Fax:405-262-1235
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice