Healthcare Provider Details

I. General information

NPI: 1033729348
Provider Name (Legal Business Name): DEAN GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 W FLAMINGO RD STE 25AB
LAS VEGAS NV
89103-3705
US

IV. Provider business mailing address

1316 NUGGET CREEK DR
LAS VEGAS NV
89108-1899
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-9917
  • Fax:
Mailing address:
  • Phone: 702-503-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: