Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D8907 | OR |
N | 122300000X | Dentist | DN17667 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2012032854 | MO |
NPI | 1205047933 |
---|---|
Provider Name | William Allen Gray |
First Address | Saint Louis, MO 63128-2745 |
Second Address | Saint Louis, MO 63128-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 02/04/2018 |