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General NPI Number Information
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NPI Number | 1316090533
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Entity Type | Individual
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Provider Name | SCOTT D. GRAY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 E. LATHAM AVE #1
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 951-925-0508
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Fax | 951-766-6776
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Provider Business Mailing Address
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Address Line | 550 E. LATHAM AVE #1
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 951-925-0508
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Fax | 951-766-6776
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36759
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License Number State | CA
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