Provider Demographics
NPI:1619043205
Name:RAYO, SAMUEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:F
Last Name:RAYO
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 1:8303 ARLINGTON BLVD
Mailing Address - Street 2:#103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-560-7200
Mailing Address - Fax:703-560-7422
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:#103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-560-7200
Practice Address - Fax:703-560-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010064261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice