Provider Demographics
NPI:1184797102
Name:GRAY, ERIC THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
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 1:475 N 300 W
Mailing Address - Street 2:SUITE 16
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3125
Mailing Address - Country:US
Mailing Address - Phone:801-543-2220
Mailing Address - Fax:
Practice Address - Street 1:475 N 300 W
Practice Address - Street 2:SUITE 16
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-3125
Practice Address - Country:US
Practice Address - Phone:801-543-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275158-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice