Provider Demographics
NPI:1134157878
Name:MAREY, RAYMOND JOSEPH (D D S)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:MAREY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16331 COPPERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16331 COPPERWOOD LN
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1940
Practice Address - Country:US
Practice Address - Phone:636-458-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0150101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice