Kenneth Ellis Bray, DMD
Individual provider Active NPI Endodontics · Albuquerque, NM
NPI 1497728653 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497728653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- DD1137 (NM)
- Practice address
- 10151 Montgomery Blvd NE
BLDG. 2 Suite B
Albuquerque, NM 87111-3670 - Phone
- (505) 830-3636
- Fax
- (505) 830-2305
- NPI assigned
- Feb 8, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD1137 | NM | MD | Endodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DD1137 | NM | Yes |
Addresses
Primary practice location
10151 Montgomery Blvd NE
BLDG. 2 Suite B
Albuquerque, NM 87111-3670
Mailing address
10151 Montgomery Blvd NE
BLDG. 2 Suite B
Albuquerque, NM 87111-3670
Phone (505) 830-3636
Other providers in Albuquerque, NM
- Darren Braude
- Elizabeth F. Braught
- Renee Diane Braught
- Maria Yellow Horse Brave Heart
- Jesse Bravo
- Lillian Madison Bray
- Misty Lynn Bray
- Clint Brayfield
- Amanda Brazier
- Ashley Brazill
All providers in Albuquerque, NM · Endodontics in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.