Provider Demographics
NPI:1134164601
Name:GARY A KOKX DMD TODD D RAY DMD PLLC
Entity type:Organization
Organization Name:GARY A KOKX DMD TODD D RAY DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-774-6553
Mailing Address - Street 1:25 LONG CREEK DR
Mailing Address - Street 2:1
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2440
Mailing Address - Country:US
Mailing Address - Phone:207-774-6553
Mailing Address - Fax:207-774-0496
Practice Address - Street 1:25 LONG CREEK DR
Practice Address - Street 2:1
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2440
Practice Address - Country:US
Practice Address - Phone:207-774-6553
Practice Address - Fax:207-774-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty