Provider Demographics
NPI:1770601759
Name:RAY, KENNETH D (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:D
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5010 E 68TH STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-492-7581
Mailing Address - Fax:918-492-1525
Practice Address - Street 1:5010 E 68TH STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-492-7581
Practice Address - Fax:918-492-1525
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3447171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics