Provider Demographics
NPI:1891053781
Name:RALPH L. RAYA DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:RALPH L. RAYA DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAN DYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-278-6444
Mailing Address - Street 1:10715 TIERRASANTA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2610
Mailing Address - Country:US
Mailing Address - Phone:858-278-6444
Mailing Address - Fax:858-279-6444
Practice Address - Street 1:10715 TIERRASANTA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2610
Practice Address - Country:US
Practice Address - Phone:858-278-6444
Practice Address - Fax:858-279-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty