Provider Demographics
NPI:1003145558
Name:ALISHA A. GRAY, D.D.S. AND CLARE E. TANNEHILL MACAULAY, D.D.S., INC
Entity Type:Organization
Organization Name:ALISHA A. GRAY, D.D.S. AND CLARE E. TANNEHILL MACAULAY, D.D.S., INC
Other - Org Name:SMILE WORKS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-733-0800
Mailing Address - Street 1:500 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-4137
Mailing Address - Country:US
Mailing Address - Phone:614-733-0800
Mailing Address - Fax:
Practice Address - Street 1:500 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-4137
Practice Address - Country:US
Practice Address - Phone:614-733-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-021936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty