Provider Demographics
NPI:1114984317
Name:GRAY, SCOTT EARL (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EARL
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 1:214 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1430
Mailing Address - Country:US
Mailing Address - Phone:937-836-4747
Mailing Address - Fax:937-832-1187
Practice Address - Street 1:214 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1430
Practice Address - Country:US
Practice Address - Phone:937-836-4747
Practice Address - Fax:937-832-1187
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-69921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice