Provider Demographics
NPI:1568795805
Name:GRAY, BILL GEORGE I (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:GEORGE
Last Name:GRAY
Suffix:I
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 1:2410 OLD DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6818
Mailing Address - Country:US
Mailing Address - Phone:281-723-3064
Mailing Address - Fax:
Practice Address - Street 1:5425 POLK ST
Practice Address - Street 2:SUITE J, MAIL CODE 1906
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-1497
Practice Address - Country:US
Practice Address - Phone:713-767-3471
Practice Address - Fax:713-767-3036
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127311223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090478101Medicaid