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General NPI Number Information
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NPI Number | 1548613086
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Entity Type | Individual
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Provider Name | JORDAN ASHLEY GRAY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 69 ALLEN ST STE 10
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-855-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 6710 OXON HILL RD STE 170
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City | OXON HILL
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State | MD
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Zip | 20745-1123
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Country | US
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Telephone | 301-686-0710
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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 | DEN1001795
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16601
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License Number State | MD
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