Provider Demographics
NPI:1306910146
Name:GRAY, ELLIOTT JONATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:JONATHAN
Last Name:GRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30103 SOUTH HAMPTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAILSBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-749-6157
Mailing Address - Fax:
Practice Address - Street 1:1346 S DIVISION ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-749-0108
Practice Address - Fax:410-749-8392
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist