MEDICARE: DR. WHITNEY 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	1223G0001X	General Practice Dentistry	1744	VI
2	1223G0001X	General Practice Dentistry	9168	NC

General Provider Information

NPI Number	:	1992171888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHITNEY GRAY DDS

Provider Business Mailing Address
First Line	:	PO BOX 7396
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00801-0396
Country	:	US
Telephone Number	:	704-996-6541
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 RAPHUNE HILL RD
Second Line	:	STE 17
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2905
Country	:	US
Telephone Number	:	340-775-1826
Fax Number	:

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

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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