Provider Demographics
NPI:1750461489
Name:GRAY, STEVEN ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:GRAY
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 1:2499 CARRIAGE COURT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7429
Mailing Address - Country:US
Mailing Address - Phone:734-528-1602
Mailing Address - Fax:
Practice Address - Street 1:2365 SOUTH HURON PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5156
Practice Address - Country:US
Practice Address - Phone:734-677-8700
Practice Address - Fax:734-677-4606
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BG7998694OtherDEA