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General NPI Number Information
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NPI Number | 1790763258
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Entity Type | Organization
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Legal Business Name | JOHN I. GRAY, III, PSC
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1303 W LEXINGTON AVE
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City | WINCHESTER
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State | KY
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Zip | 40391-3100
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Country | US
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Telephone | 859-744-0677
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Fax | 859-745-4466
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Provider Business Mailing Address
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Address Line | 1303 W LEXINGTON AVE
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City | WINCHESTER
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State | KY
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Zip | 40391-3100
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Country | US
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Telephone | 859-744-0677
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Fax | 859-745-4466
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN I GRAY III
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Credential | DMD
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Telephone | 859-744-0677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4210
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License Number State | KY
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