Provider Demographics
NPI:1740364231
Name:GRAY, GLENN JOSEPH (DDS)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:JOSEPH
Last Name:GRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN021671A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
816632OtherUNITED CONCORDIA