Provider Demographics
NPI:1720197882
Name:RAY DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:RAY DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-343-2842
Mailing Address - Street 1:110 MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6201
Mailing Address - Country:US
Mailing Address - Phone:605-343-2842
Mailing Address - Fax:605-343-2829
Practice Address - Street 1:110 MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6201
Practice Address - Country:US
Practice Address - Phone:605-343-2842
Practice Address - Fax:605-343-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0055029Medicare UPIN