MEDICARE: DR. DANIEL GRAY JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN7499	FL

General Provider Information

NPI Number	:	1669433637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL GRAY JR. D.D.S.

Provider Business Mailing Address
First Line	:	2809 N POWERS DR
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32818-3240
Country	:	US
Telephone Number	:	407-291-1056
Fax Number	:	407-291-3210

Provider Business Practice Location Address
First Line	:	2809 N POWERS DR
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32818-3240
Country	:	US
Telephone Number	:	407-291-1056
Fax Number	:	407-291-3210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/08/2007

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