Provider Demographics
NPI:1720526924
Name:ASHLEY & GRAY D.D.S.'S
Entity Type:Organization
Organization Name:ASHLEY & GRAY D.D.S.'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-252-9190
Mailing Address - Street 1:1520 E 23RD STR
Mailing Address - Street 2:STE Q
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-252-9190
Mailing Address - Fax:816-252-9390
Practice Address - Street 1:1520 E 23RD STR
Practice Address - Street 2:STE Q
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-252-9190
Practice Address - Fax:816-252-9390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLEY & GRAY D.D.S.'S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13315261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401201108Medicaid