Provider Demographics
NPI:1962767426
Name:BRAY, ELIZABETH AF (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:AF
Last Name:BRAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:FASSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4650 WEDEKIND RD SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-356-8254
Mailing Address - Fax:775-391-5947
Practice Address - Street 1:4650 WEDEKIND RD SUITE 1
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-356-8254
Practice Address - Fax:775-391-5947
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV68491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice