Provider Demographics
NPI:1568961308
Name:RAY, JAMES BECKNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BECKNER
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8661 RIO GRANDE BLVD NW # BE
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1301
Mailing Address - Country:US
Mailing Address - Phone:505-898-1338
Mailing Address - Fax:
Practice Address - Street 1:8661 RIO GRANDE BLVD NW # BE
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87114-1301
Practice Address - Country:US
Practice Address - Phone:505-898-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty