Provider Demographics
NPI:1679625016
Name:NEVILLE, RAY LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:LEE
Last Name:NEVILLE
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 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-298-7020
Mailing Address - Fax:845-298-8809
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:SUITE 308
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-298-7020
Practice Address - Fax:845-298-8809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS0409881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice