Provider Demographics
NPI:1568509214
Name:ROBERT B. RAY
Entity Type:Organization
Organization Name:ROBERT B. RAY
Other - Org Name:DBA RIDGEWOOD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-947-2922
Mailing Address - Street 1:7777 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-2458
Mailing Address - Country:US
Mailing Address - Phone:219-947-2922
Mailing Address - Fax:219-942-1876
Practice Address - Street 1:7777 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-2458
Practice Address - Country:US
Practice Address - Phone:219-947-2922
Practice Address - Fax:219-942-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8655261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental