Individual
TANNER GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 20, HOLLOMAN AFB, NM 88330
(575) 572-8099
Mailing address
49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 20, HOLLOMAN AFB, NM 88330
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12322243-9926
UT
Other
Enumeration date
04/21/2021
Last updated
09/18/2025
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