Provider Demographics
NPI:1477671774
Name:GRAY, RALPH CHARLES SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:CHARLES
Last Name:GRAY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 VALLEY ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2835
Mailing Address - Country:US
Mailing Address - Phone:973-378-2070
Mailing Address - Fax:973-378-8334
Practice Address - Street 1:71 VALLEY ST
Practice Address - Street 2:SUITE103
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2835
Practice Address - Country:US
Practice Address - Phone:973-378-2070
Practice Address - Fax:973-378-8334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 015383051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics