Provider Demographics
NPI:1235279936
Name:GRAY, WILLIAM CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
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 1:100 G T THAMES DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-8836
Mailing Address - Country:US
Mailing Address - Phone:662-324-0700
Mailing Address - Fax:
Practice Address - Street 1:100 G T THAMES DR
Practice Address - Street 2:SUITE A
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-8836
Practice Address - Country:US
Practice Address - Phone:662-324-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2615-911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice