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General NPI Number Information
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NPI Number | 1205997608
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Entity Type | Individual
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Provider Name | SANDRA D GRAY DMD
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 444 WILLIAM ST
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City | EAST ORANGE
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State | NJ
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Zip | 07017-2213
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Country | US
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Telephone | 973-675-1900
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Fax | 973-675-4021
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Provider Business Mailing Address
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Address Line | 61 PARKSIDE DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22D101572500
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License Number State | NJ
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