MEDICARE: GREGORY M. RAY D.D.S., INC.

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1578153284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY M. RAY D.D.S., INC.

Provider Business Mailing Address
First Line	:	500 S SEPULVEDA BLVD STE 305
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6977
Country	:	US
Telephone Number	:	310-219-6262
Fax Number	:	310-775-2181

Provider Business Practice Location Address
First Line	:	500 S SEPULVEDA BLVD STE 305
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6977
Country	:	US
Telephone Number	:	310-219-6262
Fax Number	:	310-775-2181

Authorized Official
Title or Position	:	CEO
Name	:	DR. GREGORY M RAY
Credential	:	DDS
Telephone Number	:	310-219-6262

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	02/04/2021

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