MEDICARE: JOSH C RAY DMD PA

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	4345	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356547608	OTHER	SC	DENTISTRY

General Provider Information

NPI Number	:	1780095422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSH C RAY DMD PA

Provider Business Mailing Address
First Line	:	2814 WOODRUFF RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-4806
Country	:	US
Telephone Number	:	864-804-9864
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 WOODRUFF RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-4806
Country	:	US
Telephone Number	:	864-804-9864
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSH C RAY
Credential	:	DMD
Telephone Number	:	864-804-9864

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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