Provider Demographics
NPI:1770637274
Name:RAY, JENNIFER GILLIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GILLIAN
Last Name:RAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 GOVERNMENT ST SUITE K-1
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-432-2664
Mailing Address - Fax:228-818-9720
Practice Address - Street 1:2113 GOVERNMENT ST STE K1
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3949
Practice Address - Country:US
Practice Address - Phone:228-432-2664
Practice Address - Fax:228-818-9720
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3184-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice