Provider Demographics
NPI:1740850486
Name:RAY, TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:2012 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9456
Mailing Address - Country:US
Mailing Address - Phone:304-368-0342
Mailing Address - Fax:
Practice Address - Street 1:2012 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9456
Practice Address - Country:US
Practice Address - Phone:304-368-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice