# GRAY TEAM LLC

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

## Provider details

- **NPI number:** 1922489673
- **Authorized official:** DR. TYSON GRAY D.M.D (OWNER)
- **Authorized official phone:** (208) 342-4644

## Contact information

- **Practice address:** 813 N STILSON RD, STE:B, BOISE, ID 83703-5119
- **Practice address phone:** (208) 342-4644
- **Practice address fax:** (208) 367-0283
- **Mailing address:** 813 N STILSON RD, STE:B, BOISE, ID 83703-5119
- **Mailing address phone:** (208) 342-4644
- **Mailing address fax:** (208) 367-0283

## Taxonomy

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

## Other

- **Enumeration date:** 06/17/2015
- **Last updated:** 06/30/2015