Healthcare Provider Details

I. General information

NPI: 1003145558
Provider Name (Legal Business Name): ALISHA A. GRAY, D.D.S. AND CLARE E. TANNEHILL MACAULAY, D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S JEFFERSON AVE
PLAIN CITY OH
43064-4137
US

IV. Provider business mailing address

500 S JEFFERSON AVE
PLAIN CITY OH
43064-4137
US

V. Phone/Fax

Practice location:
  • Phone: 614-733-0800
  • Fax:
Mailing address:
  • Phone: 614-733-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-021936
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALISHA GRAY
Title or Position: VICE PRESIDENT
Credential: D.D.S.
Phone: 614-733-0800