Healthcare Provider Details

I. General information

NPI: 1831281161
Provider Name (Legal Business Name): RICHARD G GRAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 MADISON AVE SUITE 200
NEW YORK NY
10022-5702
US

IV. Provider business mailing address

88 SECOR RD
SCARSDALE NY
10583-6953
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-0320
  • Fax: 212-371-1074
Mailing address:
  • Phone: 914-723-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number043475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: