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General NPI Number Information
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NPI Number | 1477671774
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Entity Type | Individual
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Provider Name | RALPH CHARLES GRAY SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 71 VALLEY ST SUITE103
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2835
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Country | US
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Telephone | 973-378-2070
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Fax | 973-378-8334
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Provider Business Mailing Address
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Address Line | 71 VALLEY ST SUITE103
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2835
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Country | US
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Telephone | 973-378-2070
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Fax | 973-378-8334
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DI 01538305
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License Number State | NJ
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