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NPI Code Detail

MEDICARE: DR. GORDON WARREN BRAY JR. D.M.D

MEDICARE: DR. GORDON WARREN BRAY JR. D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry252SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164503710
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON WARREN BRAY JR. D.M.D
Provider Business Mailing Address
First Line : 1376 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1100
Fax Number : 864-250-1604
Provider Business Practice Location Address
First Line : 1376 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1100
Fax Number : 864-250-1604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 05/13/2008

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