Provider Demographics
NPI:1619341922
Name:RAY, TYRUN (DDS, M,S)
Entity Type:Individual
Prefix:
First Name:TYRUN
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS, M,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 POPHAM RD STE 5/8
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4253
Mailing Address - Country:US
Mailing Address - Phone:914-725-2606
Mailing Address - Fax:914-725-1871
Practice Address - Street 1:50 POPHAM RD STE 5/8
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4253
Practice Address - Country:US
Practice Address - Phone:914-725-2606
Practice Address - Fax:914-725-1871
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057182-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics