=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568517001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD L. GRAY DMD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 W CHURCH ST
-----------------------------------------------------
City | GREER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29650-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-877-7239
-----------------------------------------------------
Fax | 864-879-2079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 W CHURCH ST
-----------------------------------------------------
City | GREER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29650-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-877-7239
-----------------------------------------------------
Fax | 864-879-2079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | DR. RONALD LLOYD GRAY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 864-877-7239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3692
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------