Provider Demographics
NPI:1639324395
Name:GRAYE, BRYAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:GRAYE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4805
Mailing Address - Country:US
Mailing Address - Phone:732-544-0050
Mailing Address - Fax:732-544-0661
Practice Address - Street 1:167 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 16
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4805
Practice Address - Country:US
Practice Address - Phone:732-544-0050
Practice Address - Fax:732-544-0661
Is Sole Proprietor?:No
Enumeration Date:2008-11-22
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023821001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry