Provider Demographics
NPI:1114489101
Name:GRAYSON, MICHELLE (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OVERBROOK PLACE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ON
Mailing Address - Zip Code:M3H4P3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 OVERBROOK PLACE
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ON
Practice Address - Zip Code:M3H4P3
Practice Address - Country:CA
Practice Address - Phone:857-544-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002058671223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty