Provider Demographics
NPI:1558445213
Name:GRAY DENTAL INC.
Entity Type:Organization
Organization Name:GRAY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-668-8877
Mailing Address - Street 1:219 HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1909
Mailing Address - Country:US
Mailing Address - Phone:610-668-8877
Mailing Address - Fax:610-668-1620
Practice Address - Street 1:219 HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1909
Practice Address - Country:US
Practice Address - Phone:610-668-8877
Practice Address - Fax:610-668-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA816632OtherUNITED CONCORDIA