Healthcare Provider Details

I. General information

NPI: 1356371793
Provider Name (Legal Business Name): RODNEY ALLEN GRAY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 CAUGHLIN SQ SUITE 2
RENO NV
89519
US

IV. Provider business mailing address

526 S TONOPAH DR STE. 200
LAS VEGAS NV
89106-4043
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-6111
  • Fax: 775-826-0919
Mailing address:
  • Phone: 702-291-2031
  • Fax: 702-366-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number817/S7-04
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: