Provider Demographics
NPI:1982863486
Name:GRAY, SAMANTHA JAMIE (DDS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JAMIE
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 1:2370 ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0622
Mailing Address - Country:US
Mailing Address - Phone:207-605-0220
Mailing Address - Fax:207-605-0224
Practice Address - Street 1:2370 ROUTE 2
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0622
Practice Address - Country:US
Practice Address - Phone:207-605-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432961999Medicaid