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General NPI Number Information
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NPI Number | 1114208667
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Entity Type | Individual
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Provider Name | DR. STEPHEN JAMES BRAY
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Gender | Male
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 1,KNEELAND STREET TUFTS SCHOOL OF DENTAL MEDICINE
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 617-636-6817
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Fax | 617-636-3831
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Provider Business Mailing Address
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Address Line | 151 TREMONT ST APT 22 B
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City | BOSTON
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State | MA
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Zip | 02111-1125
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Country | US
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Telephone | 617-202-5098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DF10675
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License Number State | MA
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