Individual
DR. STEPHEN WRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1830 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87112-3302
(505) 294-1401
Mailing address
1830 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87112-3302
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
NM1630
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
826091
UNITED CONCORDIA
NM
01
—
8957
BLUE CROSS BLUE SHEILD NU
NM
Enumeration date
06/23/2005
Last updated
08/29/2007
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