Provider Demographics
NPI:1760685374
Name:GRAY, BARBARA (DDS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8062
Mailing Address - Country:US
Mailing Address - Phone:909-874-0400
Mailing Address - Fax:909-874-0417
Practice Address - Street 1:1725 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8062
Practice Address - Country:US
Practice Address - Phone:909-874-0400
Practice Address - Fax:909-874-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice