MEDICARE: DR. WASHINGTON RAY JR. DDS

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	122300000X	Dentist	2238	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740396803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WASHINGTON RAY JR. DDS

Provider Business Mailing Address
First Line	:	625 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8190
Country	:	US
Telephone Number	:	803-773-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8190
Country	:	US
Telephone Number	:	803-773-5413
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	04/18/2016

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Directions to “ DR. WASHINGTON RAY JR. DDS” Practice Location

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