Provider Demographics
NPI:1538235775
Name:BEDDOE, RAY ANAND (PHARMD,DMD, MS)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:ANAND
Last Name:BEDDOE
Suffix:
Gender:M
Credentials:PHARMD,DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 S ELM PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7878
Mailing Address - Country:US
Mailing Address - Phone:918-451-2717
Mailing Address - Fax:918-455-1491
Practice Address - Street 1:2619 S ELM PL
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7878
Practice Address - Country:US
Practice Address - Phone:918-451-2717
Practice Address - Fax:918-455-1491
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2 49121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics