Provider Demographics
NPI:1588833289
Name:RAY, TRAVIS E (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:E
Last Name:RAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OLD KINGS RD N
Mailing Address - Street 2:A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8226
Mailing Address - Country:US
Mailing Address - Phone:386-447-1234
Mailing Address - Fax:
Practice Address - Street 1:4 OLD KINGS RD N
Practice Address - Street 2:A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8226
Practice Address - Country:US
Practice Address - Phone:386-447-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice