Provider Demographics
NPI:1609661636
Name:RAY, SPENCER (DMD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 W HILL SHADOW WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-4822
Mailing Address - Country:US
Mailing Address - Phone:480-336-0663
Mailing Address - Fax:
Practice Address - Street 1:5069 W 13400 S STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6602
Practice Address - Country:US
Practice Address - Phone:385-766-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14213335-9926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist