Provider Demographics
NPI:1356865604
Name:RAY, MARIA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ST GEORGE'S CRESCENT
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T5N 3M7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2920 CALGARY TRAIL
Practice Address - Street 2:SUITE 215
Practice Address - City:EDMONTON
Practice Address - State:ALBERTA
Practice Address - Zip Code:537
Practice Address - Country:CA
Practice Address - Phone:780-441-1101
Practice Address - Fax:780-441-1228
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN21703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty