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General NPI Number Information
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NPI Number | 1326398025
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Entity Type | Organization
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Legal Business Name | ROCHESTER ENDODONTICS, PA
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 116 ELTON HILLS LN NW SUITE 100
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City | ROCHESTER
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State | MN
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Zip | 55901-3602
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Country | US
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Telephone | 507-288-8363
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Fax | 507-288-4456
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Provider Business Mailing Address
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Address Line | 116 ELTON HILLS LN NW SUITE 100
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City | ROCHESTER
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State | MN
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Zip | 55901-3602
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Country | US
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Telephone | 507-288-8363
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Fax | 507-288-4456
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD J GRAY
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Credential | DDS, MS
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Telephone | 507-272-4912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D8111
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License Number State | MN
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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 | D13634
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D11595
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License Number State | MN
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