Provider Demographics
NPI:1750465597
Name:GRAY - WEGLOS, CATHY ANN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:ANN
Last Name:GRAY - WEGLOS
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 1:219 HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1909
Mailing Address - Country:US
Mailing Address - Phone:610-668-8877
Mailing Address - Fax:610-668-1620
Practice Address - Street 1:219 HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1909
Practice Address - Country:US
Practice Address - Phone:610-668-8877
Practice Address - Fax:610-668-1620
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028882L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice