Basic Information
| Provider Information | |||||||||
| NPI: | 1346275690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497 | ||||||||
| Address2: | 623 N 9TH STREET | ||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703473372 | ||||||||
| FaxNumber: | 8703473492 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 HWY 11 NORTH | ||||||||
| Address2: | |||||||||
| City: | DES ARC | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702563009 | ||||||||
| FaxNumber: | 8703473492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3482 | AR | Y | Dental Providers | Dentist | General Practice |
No ID Information.