Individual
HOLLY GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1812 FITZWATER ST, PHILADELPHIA, PA 19146-1852
(610) 457-2384
Mailing address
1812 FITZWATER ST, PHILADELPHIA, PA 19146-1852
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS040890
PA
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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