Healthcare Provider Details

I. General information

NPI: 1306700380
Provider Name (Legal Business Name): TIMOTHY R GRAY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13106 SE 240TH ST STE 102
KENT WA
98031-9211
US

IV. Provider business mailing address

13106 SE 240TH ST STE 102
KENT WA
98031-9211
US

V. Phone/Fax

Practice location:
  • Phone: 206-271-2678
  • Fax: 206-271-2678
Mailing address:
  • Phone: 206-271-2678
  • Fax: 206-271-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY ROSS GRAY
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 253-854-9890