Healthcare Provider Details

I. General information

NPI: 1700983921
Provider Name (Legal Business Name): LINDA L. RAY,DDS AND WILLIAM A. RAY, II, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 PLEASANT VALLEY RD
FAIRMONT WV
26554-9295
US

IV. Provider business mailing address

2012 PLEASANT VALLEY RD
FAIRMONT WV
26554-9295
US

V. Phone/Fax

Practice location:
  • Phone: 304-368-0342
  • Fax: 304-368-0341
Mailing address:
  • Phone: 304-368-0342
  • Fax: 304-368-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2897
License Number StateWV

VIII. Authorized Official

Name: DR. WILLIAM ALFRED RAY II
Title or Position: PARTNER
Credential: DDS
Phone: 304-368-0342