Provider Demographics
NPI:1346275690
Name:GRAY, ANGELA HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:HOWARD
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:623 N 9TH STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006
Mailing Address - Country:US
Mailing Address - Phone:870-347-3372
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:405 HWY 11 NORTH
Practice Address - Street 2:
Practice Address - City:DES ARC
Practice Address - State:AR
Practice Address - Zip Code:72040
Practice Address - Country:US
Practice Address - Phone:870-256-3009
Practice Address - Fax:870-347-3492
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice