MEDICARE: DEL RAY ORTHODONTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1538829866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL RAY ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	10 SE 1ST AVE STE C
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3693
Country	:	US
Telephone Number	:	561-437-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 SE 1ST AVE STE C
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3693
Country	:	US
Telephone Number	:	561-437-8668
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	FAITH GASKINS
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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Directions to “DEL RAY ORTHODONTICS LLC ” Practice Location

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