Provider Demographics
NPI:1215092333
Name:GRAY, ANITA A (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-3100
Mailing Address - Country:US
Mailing Address - Phone:859-745-4455
Mailing Address - Fax:859-745-4466
Practice Address - Street 1:1303 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-3100
Practice Address - Country:US
Practice Address - Phone:859-745-4455
Practice Address - Fax:859-745-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60050770Medicaid