Provider Demographics
NPI:1255576864
Name:GRAY, MATTHEW SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:GRAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SW 330TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6185
Mailing Address - Country:US
Mailing Address - Phone:253-835-2296
Mailing Address - Fax:253-835-7103
Practice Address - Street 1:118 SW 330TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-6185
Practice Address - Country:US
Practice Address - Phone:253-835-2296
Practice Address - Fax:253-835-7103
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice