Provider Demographics
NPI:1548675358
Name:GRAY, KALI (DMD)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
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:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OR
Mailing Address - Zip Code:97827-0929
Mailing Address - Country:US
Mailing Address - Phone:541-437-6321
Mailing Address - Fax:
Practice Address - Street 1:1400 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OR
Practice Address - Zip Code:97827
Practice Address - Country:US
Practice Address - Phone:541-437-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist