Provider Demographics
NPI:1932763893
Name:RAY, ANDREW TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TYLER
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 1:293 COLONY LN NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-7506
Mailing Address - Country:US
Mailing Address - Phone:423-284-0911
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCK MERRITT AVENUE WOMACK ORAL SURGERY CLINIC
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-6015
Practice Address - Country:US
Practice Address - Phone:910-907-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011015122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist