Provider Demographics
NPI:1336207141
Name:RAY, JOE A (DDS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:A
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683
Mailing Address - Country:US
Mailing Address - Phone:423-727-7322
Mailing Address - Fax:423-727-5051
Practice Address - Street 1:315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683
Practice Address - Country:US
Practice Address - Phone:423-727-7322
Practice Address - Fax:423-727-5051
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000028261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice