Phillip Martin Ray Jr., DMD

Primary specialty

DentistTaxonomy code 122300000X

License

11620 Issued in TN

Practice address

3603 Indiana Ave
Fort Campbell, KY 42223-5803

Phone

(270) 798-3675

NPI assigned

Jul 5, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Raytown PLLC

  • General Practice Dentistry
  • Clarksville, TN
  • NPI 1568301687
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1437720190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 GLENRAVEN DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438279",
            "telephone_number": "678-995-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3603 INDIANA AVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235803",
            "telephone_number": "270-798-3675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "PHILLIP",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-05",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "11620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Lindsay Randall III, DMD
• Billy Dean Randolph II, LCSW
• Balakrishna Mohan Rao, M.D.
• Megan Leigh Rardin, LCSW
• Christine Rasnic, RN
• Brian E Raymond, CRNA
• Scott W Reaney, PA-C
• Theodore Redman, M.D.
• Susan Redmond-Vaught, PH.D.
• Kristy L Reed, APN, FNP-C, PMHNP-BC

• Dentist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.