Provider Demographics
NPI:1336299718
Name:GRAY, ALICIA R (DDS,DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:915 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7017
Mailing Address - Country:US
Mailing Address - Phone:214-509-9011
Mailing Address - Fax:866-360-6153
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-509-9011
Practice Address - Fax:866-360-6153
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ216221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics