MEDICARE: DR. ANTHONY R GRAY DMD

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	6975	TN

General Provider Information

NPI Number	:	1710038468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY R GRAY DMD

Provider Business Mailing Address
First Line	:	1045 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:	423-478-5425
Fax Number	:	423-478-5307

Provider Business Practice Location Address
First Line	:	1045 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:	423-478-5425
Fax Number	:	423-478-5307

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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