Provider Demographics
NPI:1073309852
Name:GRAY, AUSTIN HANSEN (DMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:HANSEN
Last Name:GRAY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13192 S MIDLAKE CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7829
Mailing Address - Country:US
Mailing Address - Phone:435-760-8598
Mailing Address - Fax:
Practice Address - Street 1:5888 S 900 E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1680
Practice Address - Country:US
Practice Address - Phone:801-281-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14215615-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice