Provider Demographics
NPI:1710222021
Name:BRIAN D. RAY DMD
Entity Type:Organization
Organization Name:BRIAN D. RAY DMD
Other - Org Name:CAROLINA DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-6306
Mailing Address - Street 1:1256 BOILING SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-582-6306
Mailing Address - Fax:864-585-9593
Practice Address - Street 1:1256 BOILING SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-582-6306
Practice Address - Fax:864-585-9593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN D. RAY DMD DBA CAROLINA DENTAL STUDIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3643Medicaid