Provider Demographics
NPI:1336157577
Name:RAY, HERBERT LEE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:LEE
Last Name:RAY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3501 TERRACE ST
Mailing Address - Street 2:3064 SALK HALL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-1933
Mailing Address - Country:US
Mailing Address - Phone:412-648-8647
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE ST
Practice Address - Street 2:3064 SALK HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-1933
Practice Address - Country:US
Practice Address - Phone:412-648-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026227L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102776107001Medicaid