Provider Demographics
NPI:1609955541
Name:GRAY, CALVIN W (DDS)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:W
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 1:11260 WILBUR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2450
Mailing Address - Country:US
Mailing Address - Phone:818-368-5729
Mailing Address - Fax:818-368-9764
Practice Address - Street 1:11260 WILBUR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2450
Practice Address - Country:US
Practice Address - Phone:818-368-5729
Practice Address - Fax:818-368-9764
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice