MEDICARE: STEVEN ALLEN GRAY DDS

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	122300000X	Dentist	18447	MI

General Provider Information

NPI Number	:	1750461489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ALLEN GRAY DDS

Provider Business Mailing Address
First Line	:	2499 CARRIAGE COURT
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-7429
Country	:	US
Telephone Number	:	734-528-1602
Fax Number	:

Provider Business Practice Location Address
First Line	:	2365 SOUTH HURON PARKWAY
Second Line	:	SUITE B
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5156
Country	:	US
Telephone Number	:	734-677-8700
Fax Number	:	734-677-4606

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/07/2023

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