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General NPI Number Information
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NPI Number | 1194151571
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Entity Type | Individual
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Provider Name | IAN CAMERON GRAYSON DDS, MMSC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1717 WALDEN AVE
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4924
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Country | US
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Telephone | 716-685-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 43 OVERBROOK PLACE
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City | TORONTO
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State | ON
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Zip | M3H 4P3
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857123
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 064484-01
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License Number State | NY
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