Individual
DR. CHARLES M GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1505 EMERALD PLAZA, COLLEGE STATION, TX 77845-1501
(979) 764-7101
(979) 764-7115
Mailing address
1505 EMERALD PLAZA, COLLEGE STATION, TX 77845-1501
(979) 764-7101
(979) 764-7115
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110873003
—
TX
01
—
813315
UNITED CONCORDIA
TX
01
—
84V341
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/26/2005
Last updated
09/07/2010
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