Provider Demographics
NPI:1548613086
Name:GRAY, JORDAN ASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ASHLEY
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 1:6710 OXON HILL RD STE 170
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1123
Mailing Address - Country:US
Mailing Address - Phone:301-686-0710
Mailing Address - Fax:
Practice Address - Street 1:6710 OXON HILL RD STE 170
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1123
Practice Address - Country:US
Practice Address - Phone:301-686-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001795122300000X
MD16601122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC013323059Medicaid
MD680020300Medicaid