Provider Demographics
NPI:1770672677
Name:GRAY, DANINE FRESCH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANINE
Middle Name:FRESCH
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 1:2700 CLARENDON BLVD
Mailing Address - Street 2:R480
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5081
Mailing Address - Country:US
Mailing Address - Phone:703-525-5901
Mailing Address - Fax:703-525-0121
Practice Address - Street 1:2700 CLARENDON BLVD
Practice Address - Street 2:R480
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-7005
Practice Address - Country:US
Practice Address - Phone:703-525-5901
Practice Address - Fax:703-525-0121
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice