Provider Demographics
NPI:1235342296
Name:GRAY, JAMES BURNARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BURNARD
Last Name:GRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 CRABAPPLE ROADSUITE 240
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10930 CRABAPPLE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5813
Practice Address - Country:US
Practice Address - Phone:770-993-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics