Healthcare Provider Details

I. General information

NPI: 1104411743
Provider Name (Legal Business Name): ANDREW LAPRAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S PIONEER WAY
MOSES LAKE WA
98837-2458
US

IV. Provider business mailing address

4 SUNSET WAY STE C
HENDERSON NV
89014-2016
US

V. Phone/Fax

Practice location:
  • Phone: 509-766-9744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDENT.DE.61441754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: