Provider Demographics
NPI:1578153284
Name:GREGORY M. RAY D.D.S., INC.
Entity Type:Organization
Organization Name:GREGORY M. RAY D.D.S., INC.
Other - Org Name:GIANT SMILES DENTAL - MANHATTAN BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-219-6262
Mailing Address - Street 1:500 S SEPULVEDA BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6977
Mailing Address - Country:US
Mailing Address - Phone:310-219-6262
Mailing Address - Fax:310-775-2181
Practice Address - Street 1:500 S SEPULVEDA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6977
Practice Address - Country:US
Practice Address - Phone:310-219-6262
Practice Address - Fax:310-775-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty