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General NPI Number Information
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NPI Number | 1548489552
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Entity Type | Individual
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Provider Name | BUFFY M GRAY RDH
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 902 W MAIN ST
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City | MORRISTOWN
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State | TN
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Zip | 37814-4515
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Country | US
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Telephone | 423-586-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 995 BETH DR
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City | RUSSELLVILLE
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State | TN
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Zip | 37860-8953
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Country | US
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Telephone | 423-318-8088
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 4744
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License Number State | TN
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