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General NPI Number Information
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NPI Number | 1568027522
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Entity Type | Organization
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Legal Business Name | MEGAN N GRAY DDS LTD
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 200 S GREENLEAF ST STE I
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City | GURNEE
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State | IL
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Zip | 60031-3398
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Country | US
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Telephone | 773-216-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 620 COUNTRY LN
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City | GLENCOE
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State | IL
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Zip | 60022-2017
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Country | US
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Telephone | 773-216-8388
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEGAN N GRAY
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Credential | DDS
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Telephone | 773-216-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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