Provider Demographics
NPI:1841496791
Name:GIFFORD, D RAY (DDS)
Entity type:Individual
Prefix:
First Name:D
Middle Name:RAY
Last Name:GIFFORD
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 1:1313 BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3277
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:
Practice Address - Street 1:1318 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3206
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist