Provider Demographics
NPI:1659581726
Name:GRAYSON, GEORGE GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GERALD
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 1:600 TECUMSEH RD. EAST
Mailing Address - Street 2:140
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8X4X9
Mailing Address - Country:CA
Mailing Address - Phone:519-973-1211
Mailing Address - Fax:519-973-1108
Practice Address - Street 1:600 TECUMSEH RD. EAST
Practice Address - Street 2:140
Practice Address - City:WINDSOR
Practice Address - State:ONTARIO
Practice Address - Zip Code:N8X4X9
Practice Address - Country:CA
Practice Address - Phone:519-973-1211
Practice Address - Fax:519-973-1108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010135491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice