Provider Demographics
NPI:1376617126
Name:GRAY WHITE & ALLEN DDS PA
Entity Type:Organization
Organization Name:GRAY WHITE & ALLEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-749-0108
Mailing Address - Street 1:1346 SOUTH DIVISION ST
Mailing Address - Street 2:STE 104
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-749-0108
Mailing Address - Fax:410-749-8392
Practice Address - Street 1:1346 SOUTH DIVISION ST
Practice Address - Street 2:STE 104
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-749-0108
Practice Address - Fax:410-749-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12030122300000X
MD10353122300000X
MD4993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty