Provider Demographics
NPI:1558609800
Name:TODD A GRAY DDS, LTD
Entity Type:Organization
Organization Name:TODD A GRAY DDS, LTD
Other - Org Name:VALLEY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-782-8077
Mailing Address - Street 1:PO BOX 2260
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-2260
Mailing Address - Country:US
Mailing Address - Phone:775-782-8077
Mailing Address - Fax:775-782-6199
Practice Address - Street 1:1706 COUNTY ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4465
Practice Address - Country:US
Practice Address - Phone:775-782-8077
Practice Address - Fax:775-782-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503414Medicaid