# DR. JESSE LANE GRAY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750678538
- **Gender:** Man
- **Credential:** D.D.S, MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 00206199 | CO | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 13505 | MT | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1474 | WY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 6939 | NE | — |

## Other

- **Enumeration date:** 06/30/2011
- **Last updated:** 05/28/2025