Provider Demographics
NPI:1982782058
Name:ROBERT C. GRAY JR., DDS, P.A.
Entity type:Organization
Organization Name:ROBERT C. GRAY JR., DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:704-663-1255
Mailing Address - Street 1:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-1396
Mailing Address - Country:US
Mailing Address - Phone:704-663-1255
Mailing Address - Fax:704-663-2922
Practice Address - Street 1:602 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2538
Practice Address - Country:US
Practice Address - Phone:704-663-1255
Practice Address - Fax:704-663-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty