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NPI Code Detail

MEDICARE: MR. CHET K GRAY DDS

MEDICARE: MR. CHET K 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
11223G0001XGeneral Practice Dentistry21297TX

General Provider Information

NPI Number : 1760606081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHET K GRAY DDS
Provider Business Mailing Address
First Line : 2701 W. CUTHBERT AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79701-3819
Country : US
Telephone Number : 432-694-5741
Fax Number : 432-694-5815
Provider Business Practice Location Address
First Line : 2701 W CUTHBERT AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79701-3819
Country : US
Telephone Number : 432-694-5741
Fax Number : 432-694-5815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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