Provider Demographics
NPI:1538259908
Name:GRAY, TODD ALAN (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
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:PO BOX 2260
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-2260
Mailing Address - Country:US
Mailing Address - Phone:775-782-8077
Mailing Address - Fax:775-782-6199
Practice Address - Street 1:1701 COUNTY RD STE I
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4465
Practice Address - Country:US
Practice Address - Phone:775-782-8077
Practice Address - Fax:775-782-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV43541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503414Medicaid