Provider Demographics
NPI:1982675831
Name:WRAY, MICHAEL MAURICE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAURICE
Last Name:WRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:NAVAL BRANCH HEALTH CLINIC JACKSONVILLE
Mailing Address - Street 2:BOX 8 BLDG 964
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0008
Mailing Address - Country:US
Mailing Address - Phone:904-542-3441
Mailing Address - Fax:904-542-4937
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC JACKSONVILLE
Practice Address - Street 2:BOX 8 BLDG 964
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0008
Practice Address - Country:US
Practice Address - Phone:904-542-3441
Practice Address - Fax:904-542-4937
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY6197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist