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NPI 1538259908

NPI 1538259908 : TODD ALAN GRAY DDS : MINDEN, NV

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General NPI Number Information
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    NPI Number           |    1538259908
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    Entity Type          |    Individual 
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    Provider Name        |    TODD ALAN GRAY DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/13/2006
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    Last Update Date     |    02/17/2014
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Provider Practice Location Address
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    Address Line         |    1701 COUNTY RD STE I 
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    City                 |    MINDEN
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    State                |    NV
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    Zip                  |    89423-4465
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    Country              |    US
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    Telephone            |    775-782-8077
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    Fax                  |    775-782-6199
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Provider Business Mailing Address
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    Address Line         |    PO BOX 2260 
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    City                 |    MINDEN
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    State                |    NV
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    Zip                  |    89423-2260
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    Country              |    US
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    Telephone            |    775-782-8077
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    Fax                  |    775-782-6199
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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        |    1223P0221X
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    Taxonomy Name        |    Pediatric Dentistry
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    License Number       |    4354
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    License Number State |    NV
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