Provider Demographics
NPI:1811154438
Name:DUKE, RAY M JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:M
Last Name:DUKE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 E FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3717
Mailing Address - Country:US
Mailing Address - Phone:229-924-4054
Mailing Address - Fax:229-924-2290
Practice Address - Street 1:626 E FORSYTH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3717
Practice Address - Country:US
Practice Address - Phone:229-924-4054
Practice Address - Fax:229-924-2290
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000960176AMedicaid