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General NPI Number Information
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NPI Number | 1437591930
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Entity Type | Organization
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Legal Business Name | BLAKE W. MCRAY, D.D.S., M.S.D., INC.
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 1309 TENNESSEE ST
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City | VALLEJO
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State | CA
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Zip | 94590-4645
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Country | US
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Telephone | 707-642-3636
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Fax | 707-642-3637
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Provider Business Mailing Address
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Address Line | 1309 TENNESSEE ST
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City | VALLEJO
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State | CA
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Zip | 94590-4645
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Country | US
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Telephone | 707-642-3636
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Fax | 707-642-3637
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BLAKE WESLEY MCRAY
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Credential | D.D.S., M.S.D.
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Telephone | 707-642-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 57025
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License Number State | CA
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