Individual
DR. BRANDON P.L. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
811 W WELLINGTON AVE, CHICAGO, IL 60657-5123
(773) 871-6138
Mailing address
811 W WELLINGTON AVE, CHICAGO, IL 60657-5123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.028677
IL
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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