Provider Demographics
NPI:1265863146
Name:WRAY W.CHAFFIN II DMD,PC
Entity type:Organization
Organization Name:WRAY W.CHAFFIN II DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WRAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAFFIN
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:276-386-6231
Mailing Address - Street 1:116 RAVINE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3344
Mailing Address - Country:US
Mailing Address - Phone:276-386-6493
Mailing Address - Fax:
Practice Address - Street 1:116 RAVINE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3344
Practice Address - Country:US
Practice Address - Phone:276-386-6493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty