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General NPI Number Information
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NPI Number | 1407857527
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Entity Type | Individual
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Provider Name | RICHARD JEROME GRAY DDS
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 11092 ANDERSON ST RM 4001
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City | LOMA LINDA
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State | CA
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Zip | 92350-1706
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Country | US
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Telephone | 95-584-6819
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Fax |
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Provider Business Mailing Address
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Address Line | 11092 ANDERSON ST RM 4001
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City | LOMA LINDA
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State | CA
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Zip | 92350-1706
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Country | US
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Telephone | 909-558-4681
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401412430
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License Number State | VA
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