Provider Demographics
NPI:1992227102
Name:GRAY, ISABEL (DMD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 E HUEBBE PKWY
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1714
Mailing Address - Country:US
Mailing Address - Phone:608-362-0672
Mailing Address - Fax:
Practice Address - Street 1:1454 E HUEBBE PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1714
Practice Address - Country:US
Practice Address - Phone:608-362-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001612-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist