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NPI Code Detail

MEDICARE: DR. KEITH LESLIE RAY D.M.D.

MEDICARE: DR. KEITH LESLIE RAY D.M.D.
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
11223P0221XPediatric Dentistry5018KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902896814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH LESLIE RAY D.M.D.
Provider Business Mailing Address
First Line : 5713 BARDSTOWN RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40291-1913
Country : US
Telephone Number : 502-231-1418
Fax Number : 502-231-0051
Provider Business Practice Location Address
First Line : 5713 BARDSTOWN RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40291-1913
Country : US
Telephone Number : 502-231-1418
Fax Number : 502-231-0051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 01/04/2017

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