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General NPI Number Information
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NPI Number | 1902343148
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Entity Type | Organization
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Legal Business Name | MINDA J GRAY
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 351 E HILDEBRAND AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2412
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Country | US
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Telephone | 210-824-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 351 E HILDEBRAND AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2412
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Country | US
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Telephone | 210-824-2303
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MRS. MINDA J GRAY
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Credential | DDS
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Telephone | 210-824-2303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31920
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License Number State | TX
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