Provider Demographics
NPI:1124146600
Name:RAY, LARRY HARRISON (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:HARRISON
Last Name:RAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7341
Mailing Address - Country:US
Mailing Address - Phone:919-556-5419
Mailing Address - Fax:
Practice Address - Street 1:831 W MORGAN ST
Practice Address - Street 2:4278 MSC
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-4278
Practice Address - Country:US
Practice Address - Phone:919-838-3855
Practice Address - Fax:919-733-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist