MEDICARE: ALISHA A. GRAY, D.D.S. AND CLARE E. TANNEHILL MACAULAY, D.D.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-021936	OH

General Provider Information

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

Provider Business Mailing Address
First Line	:	500 S JEFFERSON AVE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-733-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S JEFFERSON AVE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4137
Country	:	US
Telephone Number	:	614-733-0800
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. ALISHA GRAY
Credential	:	D.D.S.
Telephone Number	:	614-733-0800

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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