Healthcare Provider Details

I. General information

NPI: 1770165862
Provider Name (Legal Business Name): CAMERON JAMES GRAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 ELTON HILLS LN NW STE 100
ROCHESTER MN
55901-3579
US

IV. Provider business mailing address

116 ELTON HILLS LN NW STE 100
ROCHESTER MN
55901-3579
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-8363
  • Fax: 507-288-4456
Mailing address:
  • Phone: 507-288-8363
  • Fax: 507-288-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7988
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS-09911
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD14662
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: