Provider Demographics
NPI:1962490607
Name:RAY, VERONICA DIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:DIANA
Last Name:RAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E STUART ST
Mailing Address - Street 2:#3120
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1195
Mailing Address - Country:US
Mailing Address - Phone:970-206-0045
Mailing Address - Fax:970-206-0107
Practice Address - Street 1:1136 E STUART ST
Practice Address - Street 2:#3120
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-206-0045
Practice Address - Fax:970-206-0107
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist