Individual
DR. NICHOLAS RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 326-1297
Mailing address
3833 S BOND AVE APT 339, PORTLAND, OR 97239-4739
(801) 842-9166
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
018002217
IL
Other
Enumeration date
07/03/2022
Last updated
07/03/2022
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