Provider Demographics
NPI:1386728871
Name:VANDERHOOK, RAY P (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:P
Last Name:VANDERHOOK
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 TRIFECTA PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4958
Mailing Address - Country:US
Mailing Address - Phone:304-725-0126
Mailing Address - Fax:304-728-0182
Practice Address - Street 1:46 TRIFECTA PL
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4958
Practice Address - Country:US
Practice Address - Phone:304-725-0126
Practice Address - Fax:304-728-0182
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics