Individual
DR. JONATHAN RUSSELL GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4344 20TH AVE S, FARGO, ND 58103-7436
(701) 239-5969
Mailing address
4344 20TH AVE S, FARGO, ND 58103-7436
(701) 239-5969
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2096
ND
Other
Enumeration date
11/30/2007
Last updated
08/19/2011
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