MEDICARE: HEIDI A RAY DMD

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	1223E0200X	Endodontics	DS027224L	PA

General Provider Information

NPI Number	:	1679825459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI A RAY DMD

Provider Business Mailing Address
First Line	:	510 PELLIS RD
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4583
Country	:	US
Telephone Number	:	724-853-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 PELLIS RD
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-4583
Country	:	US
Telephone Number	:	724-853-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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