Basic Information
| Provider Information | |||||||||
| NPI: | 1851769103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVC | ||||||||
| Address2: | BLDG H 2005 KNIGHT LANE | ||||||||
| City: | FPO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 322120140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607253213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVC | ||||||||
| Address2: | BLDG H 2005 KNIGHT LANE | ||||||||
| City: | FPO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 322120140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607253213 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 64770 | CA | Y | Dental Providers | Dentist |
No ID Information.