Provider Demographics
NPI:1417698002
Name:GRAY, DANTE LORENZO
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:LORENZO
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 NANNIE HELEN BURROUGHS AVE NE APT 414
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3771
Mailing Address - Country:US
Mailing Address - Phone:202-227-9887
Mailing Address - Fax:
Practice Address - Street 1:4800 NANNIE HELEN BURROUGHS AVE NE APT 414
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3771
Practice Address - Country:US
Practice Address - Phone:202-227-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC19708193747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant