Provider Demographics
NPI:1114055381
Name:GRAY, KALE T (DMD)
Entity Type:Individual
Prefix:
First Name:KALE
Middle Name:T
Last Name:GRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 NW CENTURY DR # 210
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3495
Mailing Address - Country:US
Mailing Address - Phone:541-243-8988
Mailing Address - Fax:
Practice Address - Street 1:810 WALNUT ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2438
Practice Address - Country:US
Practice Address - Phone:541-223-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013455122300000X
ORD98421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist