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General NPI Number Information
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NPI Number | 1669885109
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Entity Type | Organization
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Legal Business Name | WRAY FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 416 MAIN ST
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City | WRAY
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State | CO
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Zip | 80758-1725
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Country | US
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Telephone | 719-588-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 416 MAIN ST
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City | WRAY
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State | CO
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Zip | 80758-1725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RESA ESPINOZA
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Credential | DDS
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Telephone | 719-588-3036
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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 | 00202209
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License Number State | CO
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