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General NPI Number Information
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NPI Number | 1982782058
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Entity Type | Organization
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Legal Business Name | ROBERT C. GRAY JR., DDS, P.A.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 602 CARPENTER AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2538
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Country | US
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Telephone | 704-663-1255
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Fax | 704-663-2922
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Provider Business Mailing Address
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Address Line | PO BOX 1396
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City | MOORESVILLE
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State | NC
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Zip | 28115-1396
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Country | US
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Telephone | 704-663-1255
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Fax | 704-663-2922
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROBERT CHARLES GRAY JR.
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Credential | DDS,PA
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Telephone | 704-663-1255
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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 | 6563
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License Number State | NC
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