Provider Demographics
NPI:1912160912
Name:GRAY DENTAL CARE, PC
Entity Type:Organization
Organization Name:GRAY DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-385-9400
Mailing Address - Street 1:625 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2826
Mailing Address - Country:US
Mailing Address - Phone:615-385-9400
Mailing Address - Fax:615-292-5296
Practice Address - Street 1:625 BERRY RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2826
Practice Address - Country:US
Practice Address - Phone:615-385-9400
Practice Address - Fax:615-292-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205885936OtherINDIVIDUAL NPI