Provider Demographics
NPI:1790931343
Name:DR. BRUCE GRAY, PA
Entity Type:Organization
Organization Name:DR. BRUCE GRAY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-544-3672
Mailing Address - Street 1:5606 APEX HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-0000
Mailing Address - Country:US
Mailing Address - Phone:919-544-3672
Mailing Address - Fax:919-544-8958
Practice Address - Street 1:5606 APEX HIGHWAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-0000
Practice Address - Country:US
Practice Address - Phone:919-544-3672
Practice Address - Fax:919-544-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty