Provider Demographics
NPI:1760669881
Name:GINA MCCRAY DDS PA
Entity type:Organization
Organization Name:GINA MCCRAY DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OF GINA MCCRAY DDSPA/ST MARY'
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-884-3248
Mailing Address - Street 1:28160 OLD VILLAGE RD.
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659
Mailing Address - Country:US
Mailing Address - Phone:301-884-3248
Mailing Address - Fax:
Practice Address - Street 1:28160 OLD VILLAGE RD.
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659
Practice Address - Country:US
Practice Address - Phone:301-884-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GINA MCCRAY DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty