MEDICARE: DR. WILLIAM JOHN GRAY D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS025027L	PA

General Provider Information

NPI Number	:	1740307834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOHN GRAY D.M.D.

Provider Business Mailing Address
First Line	:	6149 SALTSBURG RD
Second Line	:
City	:	VERONA
State	:	PA
Zip	:	15147-3542
Country	:	US
Telephone Number	:	412-795-3333
Fax Number	:	412-793-7080

Provider Business Practice Location Address
First Line	:	6149 SALTSBURG RD
Second Line	:
City	:	VERONA
State	:	PA
Zip	:	15147-3542
Country	:	US
Telephone Number	:	412-795-3333
Fax Number	:	412-793-7080

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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