Provider Demographics
NPI:1932674108
Name:A. W. RAY DDS MD LLC
Entity Type:Organization
Organization Name:A. W. RAY DDS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:480-899-8893
Mailing Address - Street 1:928 W CHANDLER BLVD STE D-2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4900
Mailing Address - Country:US
Mailing Address - Phone:480-899-8893
Mailing Address - Fax:
Practice Address - Street 1:928 W CHANDLER BLVD STE D-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4900
Practice Address - Country:US
Practice Address - Phone:480-899-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9409OtherARIZONA STATE DENTAL BOARD