Provider Demographics
NPI:1679713341
Name:GRAY FAMILY DENTAL, PA
Entity type:Organization
Organization Name:GRAY FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-337-4344
Mailing Address - Street 1:1870 KELLER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3781
Mailing Address - Country:US
Mailing Address - Phone:817-337-4344
Mailing Address - Fax:817-337-4388
Practice Address - Street 1:1870 KELLER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3781
Practice Address - Country:US
Practice Address - Phone:817-337-4344
Practice Address - Fax:817-337-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty