Provider Demographics
NPI:1033207030
Name:GRAY, DAVID KEMP (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEMP
Last Name:GRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 OHARA TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-7961
Mailing Address - Country:US
Mailing Address - Phone:479-750-4023
Mailing Address - Fax:
Practice Address - Street 1:920 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4472
Practice Address - Country:US
Practice Address - Phone:479-751-8780
Practice Address - Fax:479-751-0465
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
799894OtherUNITED CONCORDIA
AR58577OtherBLUECROSS/BLUE SHIELD