Provider Demographics
NPI:1619393972
Name:GRAY, CARRIE ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4003
Mailing Address - Country:US
Mailing Address - Phone:203-729-3561
Mailing Address - Fax:
Practice Address - Street 1:69 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1825
Practice Address - Country:US
Practice Address - Phone:203-736-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist