Healthcare Provider Details

I. General information

NPI: 1871089102
Provider Name (Legal Business Name): RAY-AN BUHAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E JEFFERSON AVE
DETROIT MI
48226-4324
US

IV. Provider business mailing address

3024 BARTON DR
STERLING HEIGHTS MI
48310-3611
US

V. Phone/Fax

Practice location:
  • Phone: 586-819-7134
  • Fax:
Mailing address:
  • Phone: 586-819-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: