MEDICARE: DR. LEONARD G RAY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS0000003502	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0032220	OTHER	TN	BLUE CROSS BLUE SHIELD
3	630215	OTHER	TN	UNITED CONCORDIA

General Provider Information

NPI Number	:	1285617548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD G RAY DDS

Provider Business Mailing Address
First Line	:	776 S MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1405
Country	:	US
Telephone Number	:	615-792-4238
Fax Number	:	615-792-1895

Provider Business Practice Location Address
First Line	:	776 S MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1405
Country	:	US
Telephone Number	:	615-792-4238
Fax Number	:	615-792-1895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/29/2016

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