Provider Demographics
NPI:1669610515
Name:ROBERT G. RAY, DMD PC
Entity type:Organization
Organization Name:ROBERT G. RAY, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-228-3773
Mailing Address - Street 1:7360 GUILFORD DR
Mailing Address - Street 2:#102
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5124
Mailing Address - Country:US
Mailing Address - Phone:301-228-3773
Mailing Address - Fax:301-663-0971
Practice Address - Street 1:7360 GUILFORD DR
Practice Address - Street 2:#102
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5124
Practice Address - Country:US
Practice Address - Phone:301-228-3773
Practice Address - Fax:301-663-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD65161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty