MEDICARE: DR. ALISHA ANDERSON GRAY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-021936	OH

General Provider Information

NPI Number	:	1346316361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISHA ANDERSON GRAY D.D.S.

Provider Business Mailing Address
First Line	:	500 S JEFFERSON AVE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-733-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S JEFFERSON AVE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-733-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/06/2014

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