Provider Demographics
NPI:1568694909
Name:GRAY, WESLEY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:D
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 1:2701 W CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3819
Mailing Address - Country:US
Mailing Address - Phone:432-694-5741
Mailing Address - Fax:432-694-5815
Practice Address - Street 1:2701 W CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3819
Practice Address - Country:US
Practice Address - Phone:432-694-5741
Practice Address - Fax:432-694-5815
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00247431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice