Individual
DR. TYSON N. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
813 STILSON RD. SUITE B, MILLENNIUM FAMILY DENTAL BOISE LLC, BOISE, ID 83703
(208) 342-4644
(208) 888-2094
Mailing address
1848 MILLENIUM WAY, MERIDIAN, ID 83642-1510
(208) 888-2026
(208) 888-2094
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3799
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806871400
—
ID
Enumeration date
10/31/2006
Last updated
12/30/2014
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