Provider Demographics
NPI:1215225495
Name:GRAY, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:1337 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4373
Mailing Address - Country:US
Mailing Address - Phone:970-221-3020
Mailing Address - Fax:970-482-7562
Practice Address - Street 1:2032 LOWE ST UNIT 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5743
Practice Address - Country:US
Practice Address - Phone:970-221-3020
Practice Address - Fax:970-482-7562
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice