Healthcare Provider Details

I. General information

NPI: 1740481019
Provider Name (Legal Business Name): ROBERT G. RAY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 8TH ST SE
WASHINGTON DC
20003
US

IV. Provider business mailing address

411 8TH ST SE
WASHINGTON DC
20003
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-3330
  • Fax: 202-543-3335
Mailing address:
  • Phone: 202-543-3330
  • Fax: 202-543-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6516
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN2893
License Number StateDC

VIII. Authorized Official

Name: DR. ROBERT G RAY
Title or Position: OWNER DOCTOR
Credential: DMD
Phone: 202-543-3330