Individual
JAMES DOUGLAS GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS DENTIST
Contact information
Practice address
636 MICHIGAN AVE, OROFINO, ID 83544-0872
(208) 476-4917
(208) 476-4071
Mailing address
PO BOX 872, OROFINO, ID 83544-0872
(208) 476-4917
(208) 476-4071
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1776
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001238000
—
ID
01
—
40523
REJENCE
ID
01
—
67835
B CROSS
ID
Enumeration date
08/14/2006
Last updated
07/08/2007
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