Basic Information
| Provider Information | |||||||||
| NPI: | 1598867863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51005 WINNANS RILEY BARRACKS EAST WING | ||||||||
| Address2: | HQS, USA DENTAC | ||||||||
| City: | FORT HUACHUCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856137040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205333144 | ||||||||
| FaxNumber: | 5205337285 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 E. WINROW | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT HUACHUCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856137040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205333144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 4023 | AZ | Y | Dental Providers | Dentist | General Practice |
No ID Information.