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General NPI Number Information
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NPI Number | 1558609800
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Entity Type | Organization
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Legal Business Name | TODD A GRAY DDS, LTD
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 1706 COUNTY ROAD SUITE 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 | OWNER
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Name | DR. TODD A GRAY
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Credential | DDS
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Telephone | 775-782-8077
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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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