Provider Demographics
NPI:1306088752
Name:GRAY, MARK A (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2257 MAIN STREET EAST
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-972-2800
Mailing Address - Fax:770-972-9255
Practice Address - Street 1:2257 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3499
Practice Address - Country:US
Practice Address - Phone:770-972-2800
Practice Address - Fax:770-972-9255
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0123691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics