Provider Demographics
NPI:1710602578
Name:DUI, RAY SHANE
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:SHANE
Last Name:DUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 BRANHAM LN STE A8
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-5227
Mailing Address - Country:US
Mailing Address - Phone:408-798-1731
Mailing Address - Fax:
Practice Address - Street 1:1711 BRANHAM LN STE A8
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-5227
Practice Address - Country:US
Practice Address - Phone:408-798-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice