Provider Demographics
NPI:1790846053
Name:GRAYER, CLIFTON JR (DMD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:GRAYER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1711
Mailing Address - Country:US
Mailing Address - Phone:781-235-5700
Mailing Address - Fax:781-235-7901
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-235-5700
Practice Address - Fax:781-235-7901
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics