Michael L Ray, DDS
Individual provider Active NPI Dentist · Ingram, TX
NPI 1104014505 · NPPES record last updated Mar 19, 2009
Key facts
- NPI
- 1104014505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11678 (TX)
- Practice address
- 3164 Junction Hwy
Suite West-1
Ingram, TX 78025-3131 - Phone
- (830) 367-1171
- NPI assigned
- Oct 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11678 | TX | Yes |
Addresses
Primary practice location
3164 Junction Hwy
Suite West-1
Ingram, TX 78025-3131
Mailing address
3164 Junction Hwy
Suite West-1
Ingram, TX 78025-3131
Phone (830) 367-1171
Other providers in Ingram, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.