Healthcare Provider Details

I. General information

NPI: 1093713224
Provider Name (Legal Business Name): RAY DOUGLAS DAMERAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 WESTWOOD DR STE F
HAMILTON MT
59840-5317
US

IV. Provider business mailing address

1150 WESTWOOD DR STE F
HAMILTON MT
59840-5317
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-9218
  • Fax: 406-375-9015
Mailing address:
  • Phone: 406-375-9218
  • Fax: 406-375-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1948
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number18459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: