Provider Demographics
NPI:1215071626
Name:GRAY, TAMARA KAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:KAY
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 KELLER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3781
Mailing Address - Country:US
Mailing Address - Phone:817-337-4344
Mailing Address - Fax:817-337-4388
Practice Address - Street 1:1870 KELLER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3781
Practice Address - Country:US
Practice Address - Phone:817-337-4344
Practice Address - Fax:817-337-4388
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice