Provider Demographics
NPI:1518273259
Name:STEVEN MARK FRAY, DMD, PC
Entity Type:Organization
Organization Name:STEVEN MARK FRAY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-853-3643
Mailing Address - Street 1:5590 CHALKVILLE RD
Mailing Address - Street 2:STE A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-8636
Mailing Address - Country:US
Mailing Address - Phone:205-853-3643
Mailing Address - Fax:205-853-7947
Practice Address - Street 1:5590 CHALKVILLE RD
Practice Address - Street 2:STE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-8636
Practice Address - Country:US
Practice Address - Phone:205-853-3643
Practice Address - Fax:205-853-7947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty