Provider Demographics
NPI:1821248709
Name:DRAY, GEOFFREY SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:SCOTT
Last Name:DRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:G.
Other - Middle Name:S
Other - Last Name:DRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:P.O. BOX 422
Mailing Address - Street 2:
Mailing Address - City:MT. CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851
Mailing Address - Country:US
Mailing Address - Phone:570-339-2100
Mailing Address - Fax:
Practice Address - Street 1:116 S. OAK
Practice Address - Street 2:
Practice Address - City:MT. CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851
Practice Address - Country:US
Practice Address - Phone:570-339-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021023L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty