# L DOUGLAS GRAY DDS AND KENNETH K LO DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Roosevelt Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326268640
- **Authorized official:** DR. LLOYD DOUGLAS GRAY DDS (OWNER)
- **Authorized official phone:** (206) 524-6100

## Contact information

- **Practice address:** 6417 ROOSEVELT WAY NE, \#206, SEATTLE, WA 98115
- **Practice address phone:** (206) 524-6100
- **Practice address fax:** (206) 522-4608
- **Mailing address:** 6417 ROOSEVELT WAY NE, \#206, SEATTLE, WA 98115
- **Mailing address phone:** (206) 524-6100
- **Mailing address fax:** (206) 522-4608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | WA | Yes |

## Other

- **Enumeration date:** 04/27/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 114742 | L AND I | WA |