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: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

IV. Provider business mailing address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1333
  • Fax:
Mailing address:
  • Phone: 402-472-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7988
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09911
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDDS-09911
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14662
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: