Provider Demographics
NPI:1598887440
Name:GRAYSON, ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EAST 30 ST
Mailing Address - Street 2:#16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-279-1174
Mailing Address - Fax:
Practice Address - Street 1:350 FIFTH AVE
Practice Address - Street 2:SUITE 5222
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:212-279-1174
Practice Address - Fax:212-594-8936
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice