Individual
MEGAN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 656-0044
(262) 764-3636
Mailing address
625 57TH ST, SUITE 700, KENOSHA, WI 53140-4146
(262) 764-3622
(262) 764-3636
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019027924
IL
122300000X
Dentist
Primary
1001011
WI
122300000X
Dentist
FD1476488
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780819599
—
WI
Enumeration date
05/22/2009
Last updated
11/21/2014
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