Provider Demographics
NPI:1053541219
Name:RAY, ANDREW WILLIAM (DDS, MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 N ALMA SCHOOL RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1435
Mailing Address - Country:US
Mailing Address - Phone:210-771-5761
Mailing Address - Fax:
Practice Address - Street 1:2421 GOOSEBERRY CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8567
Practice Address - Country:US
Practice Address - Phone:210-771-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094091223S0112X
KY88551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FR1999549OtherDEA# DRUG ENFORCEMENT AGENCY