Healthcare Provider Details

I. General information

NPI: 1568795805
Provider Name (Legal Business Name): BILL GEORGE GRAY I D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 POLK ST SUITE J, MAIL CODE 1906
HOUSTON TX
77023-1497
US

IV. Provider business mailing address

2410 OLD DIXIE DR
RICHMOND TX
77406-6818
US

V. Phone/Fax

Practice location:
  • Phone: 713-767-3471
  • Fax: 713-767-3036
Mailing address:
  • Phone: 281-723-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number12731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: