Provider Demographics
NPI:1982710398
Name:RAY M DUKE JR DMD PC
Entity Type:Organization
Organization Name:RAY M DUKE JR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-924-4054
Mailing Address - Street 1:626 EAST FORSYTH STREET
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709
Mailing Address - Country:US
Mailing Address - Phone:229-924-4054
Mailing Address - Fax:229-924-2290
Practice Address - Street 1:626 EAST FORSYTH STREET
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709
Practice Address - Country:US
Practice Address - Phone:229-924-4054
Practice Address - Fax:229-924-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000960176AMedicaid