MEDICARE: CALVIN W GRAY D.D.S.

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
1	1223G0001X	General Practice Dentistry	24789	CA

General Provider Information

NPI Number	:	1609955541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVIN W GRAY D.D.S.

Provider Business Mailing Address
First Line	:	11260 WILBUR AVE
Second Line	:	SUITE 201
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2450
Country	:	US
Telephone Number	:	818-368-5729
Fax Number	:	818-368-9764

Provider Business Practice Location Address
First Line	:	11260 WILBUR AVE
Second Line	:	SUITE 201
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2450
Country	:	US
Telephone Number	:	818-368-5729
Fax Number	:	818-368-9764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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