MEDICARE: DR. PRESTON FORD GRAY DDS

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	122300000X	Dentist	206514	CO
2	122300000X	Dentist	34212	TX

General Provider Information

NPI Number	:	1700379666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRESTON FORD GRAY DDS

Provider Business Mailing Address
First Line	:	33018 WEATHERBY CT
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-4266
Country	:	US
Telephone Number	:	281-610-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 E HARMONY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9504
Country	:	US
Telephone Number	:	970-287-3701
Fax Number	:

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	03/03/2026

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