Provider Demographics
NPI:1811336753
Name:GRAY, HANS PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:HANS
Middle Name:PETER
Last Name:GRAY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20619 ROLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3858
Mailing Address - Country:US
Mailing Address - Phone:801-870-0142
Mailing Address - Fax:
Practice Address - Street 1:1245 SE 3RD ST STE A1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2162
Practice Address - Country:US
Practice Address - Phone:541-318-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-1561223P0221X
ORD107571223P0221X
HIDTT-251390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty