Provider Demographics
NPI:1619170271
Name:RAY, JAROM JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAROM
Middle Name:JOSEPH
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 1:2355B FACULTY DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-1802
Mailing Address - Country:US
Mailing Address - Phone:719-373-0733
Mailing Address - Fax:
Practice Address - Street 1:2355B FACULTY DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-1802
Practice Address - Country:US
Practice Address - Phone:719-373-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5371953-9921122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist