Provider Demographics
NPI:1528698511
Name:M GRAY POND DMD LLC
Entity type:Organization
Organization Name:M GRAY POND DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-631-3743
Mailing Address - Street 1:1021 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2559
Mailing Address - Country:US
Mailing Address - Phone:205-631-3743
Mailing Address - Fax:
Practice Address - Street 1:1021 FULTON AVE
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2559
Practice Address - Country:US
Practice Address - Phone:205-631-3743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental