Provider Demographics
NPI:1326398025
Name:ROCHESTER ENDODONTICS, PA
Entity Type:Organization
Organization Name:ROCHESTER ENDODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:507-272-4912
Mailing Address - Street 1:116 ELTON HILLS LN NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3602
Mailing Address - Country:US
Mailing Address - Phone:507-288-8363
Mailing Address - Fax:507-288-4456
Practice Address - Street 1:116 ELTON HILLS LN NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3602
Practice Address - Country:US
Practice Address - Phone:507-288-8363
Practice Address - Fax:507-288-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115951223E0200X
MND81111223E0200X
MND136341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty