Healthcare Provider Details

I. General information

NPI: 1326016908
Provider Name (Legal Business Name): JILL LAVONNE GRAY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 8TH ST
MARYSVILLE KS
66508-1907
US

IV. Provider business mailing address

201 S 8TH ST
MARYSVILLE KS
66508-1907
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-5323
  • Fax: 844-270-3105
Mailing address:
  • Phone: 785-562-5323
  • Fax: 844-270-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberKS 60212
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: