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General NPI Number Information
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NPI Number | 1679775753
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Entity Type | Organization
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Legal Business Name | ROBERT G. RAY D.M.D PC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 918 FAIRLAWN AVE
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City | LAUREL
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State | MD
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Zip | 20707-4806
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Country | US
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Telephone | 301-490-6922
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Fax |
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Provider Business Mailing Address
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Address Line | 918 FAIRLAWN AVE
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City | LAUREL
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State | MD
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Zip | 20707-4806
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Country | US
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Telephone | 301-490-6922
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT G RAY
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Credential | D.M.D
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Telephone | 301-490-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6516
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License Number State | MD
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