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General NPI Number Information
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NPI Number | 1396999520
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Entity Type | Organization
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Legal Business Name | GRAY COSMETIC AND FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 2701 W CUTHBERT AVE
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City | MIDLAND
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State | TX
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Zip | 79701-3819
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Country | US
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Telephone | 432-694-5741
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Fax | 432-694-5815
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Provider Business Mailing Address
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Address Line | 2701 W CUTHBERT AVE
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City | MIDLAND
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State | TX
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Zip | 79701-3819
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Country | US
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Telephone | 432-694-5741
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Fax | 432-694-5815
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHET K GRAY
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Credential | DDS
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Telephone | 432-694-5741
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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 | 21297
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License Number State | TX
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